Hashimoto Akira, Sonohata Motoki, Hirata Hirohito, Kawano Shunsuke, Eto Shuichi, Ueno Masaya, Mawatari Masaaki
Department of Orthopaedic Surgery, Faculty of Medicine, Saga University, Nabeshima 5-1-1, 849-8501, Saga, Japan.
Research Center of Arthroplasty, Faculty of Medicine, Saga University, Nabeshima 5-1-1, 849-8501, Saga, Japan.
BMC Musculoskelet Disord. 2021 Jan 6;22(1):19. doi: 10.1186/s12891-020-03879-x.
Of late, periarticular analgesic injection (PAI) has become a common alternative treatment for pain following total hip arthroplasty (THA). However, the systemic effects of PAI containing corticosteroids in patients subjected to THA have not been investigated. This study evaluated the analgesic efficacy and systemic effects of PAI containing a corticosteroid in patients subjected to THA.
This single-center, retrospective cohort study enrolled patients undergoing unilateral, primary THA. A total of 197 patients (200 hips) were included in the final analyses, with 87 hips in the PAI group and 113 hips in the control group. Numeric Rating Scale (NRS) and laboratory data were assessed preoperatively and on postoperative days (POD) 1 and 7. Pearson's correlation coefficients were obtained to assess the correlations between the D-dimer level on POD 7 and each outcome measure on POD 1.
The postoperative white blood cell count (WBC) was significantly higher in the PAI group than in the control group. Postoperative NRS, creatine phosphokinase (CK), and C-reactive protein (CRP) levels were significantly lower in the PAI group. D-dimer levels were significantly lower in the PAI group on POD 7. Postoperative aspartate transaminase (AST), alanine aminotransferase, blood urea nitrogen, and creatinine levels were within reference ranges. D-dimer levels on POD 7 showed a significant negative correlation with WBC on POD 1 (r=-0.4652) and a significant positive correlation with the NRS score and AST, CK, CRP, and D-dimer levels on POD 1 (r = 0.1558, 0.2353, 0.2718, 0.3545, and 0.3359, respectively).
PAI containing a corticosteroid may be an effective treatment for pain and inflammation after THA, and it does not seem to cause drug-induced liver or kidney injury. Moreover, corticosteroid PAI can may accelerate early ambulation, which prevents the elevation of postoperative D-dimer levels, and may reduce the risk of deep venous thrombosis.
近年来，关节周围镇痛注射（PAI）已成为全髋关节置换术（THA）后疼痛的一种常见替代治疗方法。然而，接受THA的患者中含皮质类固醇的PAI的全身影响尚未得到研究。本研究评估了含皮质类固醇的PAI对接受THA的患者的镇痛效果和全身影响。
本单中心回顾性队列研究纳入了接受单侧初次THA的患者。最终分析共纳入197例患者（200髋），PAI组87髋，对照组113髋。术前及术后第1天和第7天评估数字评定量表（NRS）和实验室数据。获得Pearson相关系数以评估术后第7天的D-二聚体水平与术后第1天的各结局指标之间的相关性。
PAI组术后白细胞计数（WBC）显著高于对照组。PAI组术后NRS、肌酸磷酸激酶（CK）和C反应蛋白（CRP）水平显著较低。PAI组术后第7天的D-二聚体水平显著较低。术后天冬氨酸转氨酶（AST）、丙氨酸转氨酶、血尿素氮和肌酐水平均在参考范围内。术后第7天的D-二聚体水平与术后第1天的WBC呈显著负相关（r=-0.4652），与术后第1天的NRS评分、AST、CK、CRP和D-二聚体水平呈显著正相关（r分别为0.1558、0.2353、0.2718、0.3545和0.3359）。
含皮质类固醇的PAI可能是THA后疼痛和炎症的有效治疗方法，且似乎不会引起药物性肝或肾损伤。此外，皮质类固醇PAI可能会加速早期活动，从而防止术后D-二聚体水平升高，并可能降低深静脉血栓形成的风险。
