| Objective: Osteoarthritis is a common chronic degenerative joint disease,The disease occurred in the elderly, especially the knee joint most often involved. Patients with advanced knee OA, quality of life was significantly decreased. After decades of development the total knee arthroplasty has become the treatment of knee joint diseases in the terminal stage of the routine operation. However, most of the TKA patients with severe pain, lasted for a long time, postoperative pain is always difficult problem for surgeons and patients. At present, many TKA perioperative analgesia, the intraoperative periarticular injection infiltration analgesia as a novel analgesic method, has become a hotspot in the research of the people. The periarticular injection infiltration analgesia is a local anesthetic or joint opioids, adrenaline, steroidal anti-inflammatory drug, or non-steroidal anti-inflammatory drugs such as mixture of several local periarticular injection, known as the "cocktail" analgesia,, but at present, periarticular injection mixture no unified standard. Especially for corticosteroid whether to join mixture of controversial: some scholars believe that steroidal anti- inflammatory drugs may increase the risk of infection, for TKA postoperative analgesia and the recovery of knee joint function doesn’t work, is not recommended; some scholars believe that TKA injection of corticosteroids can reduce postoperative pain, promote the kneejoint function rehabilitation, it is recommended to use. The study found that IL-1β, IL-6, TNF-a and other inflammatory factors is closely related with pain, and corticosteroid can inhibit inflammatory reaction, so as to ease the pain. So we speculated that TKA intraoperative injection of corticosteroid can inhibit inflammatory reaction, reduce the local and systemic IL-1, IL-6, TNF-a and other inflammatory factors, can alleviate the pain after TKA. But the current lack of research on the effect of local and systemic inflammatory factors after injection of corticosteroid in TKA operation,and single periarticular injection with corticosteroid did not report. This study selected 50 cases of patients with knee OA line to TKA, Comparison of TKA with single periarticular injection with corticosteroid and does not, effect of corticosteroid on pain, knee joint function and systemic and local inflammatory factor after operation in other therapy and analgesia method under the condition of the same, to provide the theoretical basis for periarticular injection with steroid in TKA operation. Methods: From June 1, 2014 to December 31, 2014 in our hospital during the period of bone and joint surgery for unilateral TKA knee OA patients 50 cases, were randomly divided into experimental group and control group, 25 cases in each group. The experimental group of betamethasone 1ml, physiological saline with 50 ml mixed periarticular injection; the control group take physiological saline with 50 ml mixed periarticular injection in TKA operation. The injection site was: knee posteromedial(posterior articular capsule, semimembranosus, PES anserinus tendons, oblique popliteal ligament and soft tissue),posterolateral knee(after the popliteus tendon, joint capsule, unit two biceps tendon and soft tissue), the posterior aspect of the knee joint capsule, and the anterior tibial periosteum. After operation, two groups were given patient-controlled intravenous analgesia. Observation of postoperative 4,8,12,24,48,72 h rest pain VAS, postoperative 1,2,3 days after the pain VAS; the time required for postoperative limb straight leg raising up to 30 degrees; the maximum angle of knee flexion at 1,2,3,7 days after operation; The seventh day after operation and in January postoperative knee Hss scores.Record the postoperative analgesic usage: the dose intravenous analgesia pump consumption, use of time, press the number of records, nausea and vomiting and other adverse reactions after operation. Determination of preoperative and postoperative day 1,3,7 C reactive protein, interleukin 1β and 6 tumor necrosis factor-a; record the postoperative drainage in 24 hours, In postoperative drainage fluid, IL- 6 and IL – 1β, TNF- a. Results:50 patients were entered into the statistical analysis, compared two groups of patients with basic situation and operation situation, the difference was not statistically significant(P>0.05). Experimental group 1 patients and the control group 2 patients postoperative 5 days still appear incision around a small number of scientists by considered is fat liquefaction, strengthen the treatment after the incision healed well. The remaining patients had postoperative 7-9 days out of the hospital and outpatient 4-6 weeks. Experimental postoperative 4 h, 8 h, 12 h, 24 h, 48 h, 72 h resting pain VAS score lower than the control group, but the differencesbetween the two groups had no statistical significance(P > 0.05); Postoperative VAS pain in1, 2, 3 days after the score, there was no significant difference between the two groups(P>0.05).Comparison of postoperative PCIA time, consumption, pressing times, between two groups was not statistically significant(P>0.05).Early rehabilitation of knee joint function after operation were compared between two groups. The experimental group patients after the straight leg raising 30 time average value is lower than the control group, but the difference was not statistically significant(P>0.05). The average value of the experimental group postoperative knee joint activity of POD1, 2, 3, 7 statistics are higher than the corresponding control group but the difference had no statistical significance(P>0.05).Seventh days after operation were compared between two groups, after January the HSS knee score, there was no significant difference between the two groups(P>0.05). Comparing the two groups of patients before and after 1, 3, 7 days of serum CRP, IL-1β, IL-6, TNF-a, the difference was not statistically significant(P>0.05).IL-1β, IL-6, TNF-a in the liquid drainage after operation, the statistical value of the experimental group were lower than the control group, the difference was statistically significant(P<0.05).Conclusion: The periarticular injection with corticosteroid can reduce the postoperative knee joint cavity around IL-1β,IL-6, TNF-a inflammatory factors, the peripheral blood, IL-1β,IL-6, TNF-a, inflammatory factor has no obvious influence, can reduce the local inflammatory reaction in TKA, can reduce the early postoperative pain score and increase early the knee jointmobility and reduce postoperative analgesic dosage, but there was nostatistically significant difference,no wound infection and other complications, has not led to the recent infection increased. |
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