Rytter Søren, Stilling Maiken, Munk Stig, Hansen Torben Bæk
Department of Orthopedics, University Clinic for Hand, Hip and Knee Surgery, Regional Hospital West Jutland, Lægårdvej 12, 7500, Holstebro, Denmark.
Department of Clinical Medicine, University of Aarhus, Aarhus, Denmark.
Knee Surg Sports Traumatol Arthrosc. 2017 Jan;25(1):284-290. doi: 10.1007/s00167-014-3501-8. Epub 2015 Jan 7.
Unicompartmental knee arthroplasty (UKA) results in less operative trauma and faster patient recovery than after a conventional total knee arthroplasty. Despite an increased focus on multimodal analgesic strategies, there is still a substantial level of patient-reported pain in the early postsurgical period after UKA. The purpose of the study was to evaluate the effect of a single preoperative dose of systemic methylprednisolone on postsurgical pain after fast-track UKA.
Seventy-two patients in two consecutive series undergoing unilateral UKA were included in a prospective cohort study. The patients (n = 35) in the treatment group received a single preoperative dose of systemic methylprednisolone 125 mg, whereas the control group (n = 37) did not. Outcome measures were postsurgical pain at rest and during walking, consumption of opioids for pain rescue, knee swelling and knee range of motion, and complications.
In the first 24 h after surgery, the treatment group had less pain at rest (p < 0.001) and during walking (p < 0.001) and less consumption of opioids (p = 0.01) in comparison with the control group. Furthermore, the treatment group had 2.2 cm less knee swelling (p = 0.02) in the first post-operative day, and better knee extension (p = 0.004), whereas knee flexion was similar (n.s.) between groups. No serious complications were associated with the treatment.
Addition of a single preoperative dose of 125 mg systemic methylprednisolone to a multimodal analgesic regime significantly reduced postsurgical pain and opioid consumption and decreased knee swelling in the first 24 h after fast-track UKA.
Therapeutic study, Level II.
单髁膝关节置换术（UKA）比传统全膝关节置换术造成的手术创伤更小，患者恢复更快。尽管越来越关注多模式镇痛策略，但UKA术后早期患者报告的疼痛程度仍然很高。本研究的目的是评估术前单次静脉注射甲泼尼龙对快速康复UKA术后疼痛的影响。
连续两个系列的72例接受单侧UKA的患者纳入前瞻性队列研究。治疗组（n = 35）患者术前接受单次静脉注射甲泼尼龙125 mg，而对照组（n = 37）未接受。观察指标包括术后静息和行走时的疼痛、用于止痛的阿片类药物消耗量、膝关节肿胀和膝关节活动范围以及并发症。
与对照组相比，治疗组术后24小时内静息时（p < 0.001）和行走时（p < 0.001）疼痛较轻，阿片类药物消耗量较少（p = 0.01）。此外，治疗组术后第一天膝关节肿胀减少2.2 cm（p = 0.02），膝关节伸展更好（p = 0.004），而两组之间膝关节屈曲情况相似（无统计学差异）。治疗未出现严重并发症。
在多模式镇痛方案中术前单次静脉注射125 mg甲泼尼龙可显著减轻快速康复UKA术后疼痛和阿片类药物消耗量，并在术后24小时内减轻膝关节肿胀。
治疗性研究，二级。
