观察膝关节周围多点注射在膝关节镜快速康复外科（FTS）的应用效果。

采用前瞻性研究，选取2016年6月至2019年6月于河北医科大学第三医院关节科接受膝关节镜手术患者60例，采用随机数表法与双盲原则分为观察组与对照组，各30例。2组患者均采用侧卧位行腰硬联合麻醉，观察组行膝关节周围注射镇痛，对照组使用生理盐水在相对位置进行多点注射。2组均于术后48 h内常规使用静脉自控镇痛泵（PCIA）进行镇痛。比较2组治疗效果、术后功能锻炼开始时间、满意度及PCIA按压次数；比较2组术后4、8、12、24 h静息及运动视觉模拟评分（VAS）及术后并发症情况。

治疗后观察组优良率显著高于对照组，差异有统计学意义（93.33% vs 73.33%；χ²=4.320，P＜0.05）。观察组患者术后首次功能锻炼时间、首次下床时间显著短于对照组（t=11.478、13.884，P＜0.05），术后镇痛满意度显著高于对照组（t=3.935，P＜0.05），PCIA按压次数显著少于对照组（t=15.492，P＜0.05）。2组术后4、8 h静息及运动VAS评分差异无统计学意义（P＞0.05），观察组患者术后12、24 h静息及运动VAS评分显著低于对照组（P＜0.05）。观察组术后并发症总发生率与对照组比较，差异无统计学意义（6.67% vs 10.00%；χ²=0.218，P＞0.05）。

膝关节周围注射镇痛联合PCIA效果优于常规静脉PCIA，操作便利，不影响术后关节活动和功能锻炼，更适用于FTS且具有临床推广应用价值。

To observe the effects of multi-point injection around the knee joint in fast-track arthroscopic knee surgery.

In this prospective study, 60 patients who received arthroscopic knee surgery at Department of Orthopaedics of Third Hospital of Hebei Medical University from June 2016 to June 2019 were selected and divided into either an observation group or a control group using the random number table method according to the double-blind principle, with 30 patients in each group. Patients in both groups were given combined spinal epidural anesthesia in the lateral decubitus position. The observation group received analgesia injection around the knee joint, and the control group received multi-point injection of normal saline. Both groups were routinely treated with an intravenous self-controlled analgesia pump (PCIA) within 48 h after surgery. The effects, start time of functional exercise, satisfaction, and PCIA press times were compared between the two groups. The rest and movement visual analogue scale (VAS) scores were compared between the two groups at 4, 8, 12, and 24 h after surgery. The postoperative complications were compared between the two groups.

The excellent and good rate after treatment in the observation group was 93.33%, which was significantly higher than that of the control group (73.33%; χ²=4.320, P＜0.05). The time to first functional exercise and the time to ambulation were significantly shorter in the observation group than in the control group (t=11.478 and 13.884, respectively, P＜0.05). Postoperative analgesia satisfaction was significantly higher in the observation group than that in the control group (t=3.935, P＜0.05). The number of PCIA press times in the observation group was significantly less than that of the control group (t=15.492, P＜0.05). There was no significant difference in rest and movement VAS scores at 4 and 8 h after surgery between the two groups (P＞0.05). Rest and movement VAS scores at 12 and 24 h after operation in the observation group were significantly lower than those of the control group (P＜0.05). The total incidence of postoperative complications had no significant difference between the two groups (6.67% vs 10.00%; χ²=0.218, P＞0.05).

The effect of periarticular injection analgesia combined with PCIA is better than that of conventional intravenous PCIA, which is convenient and does not affect postoperative joint activity and functional exercise. It is more suitable for fast-track surgery and has clinical application value.