全膝关节置换后神经传导阻滞联合康复治疗对功能预后的影响:随机对照  

Effect of femoral nerve block and neural rehabilitation on functional outcome after total knee replacement:A randomized controlled study

作　　者：王江林[1] 杨敏[1] 胥方元[1] 

机构地区：[1]泸州医学院附属医院康复医学科,四川省泸州市646000

出　　处：《中国组织工程研究与临床康复》2011年第22期4015-4018,共4页Journal of Clinical Rehabilitative Tissue Engineering Research

摘　　要：背景：全膝关节置换持续的股神经阻滞效果好于单纯镇痛剂治疗（吗啡）;而相对于持续的神经阻滞,单次注射法不需要专用的设备、特殊的仪器和专人管理,操作更加简单,费用也更低。目的：观察单次股神经传导阻滞联合神经康复治疗对缓解全膝关节置换后疼痛、促进功能恢复的作用。方法：40例全膝关节置换患者分为2组,试验组注射40mL2.5g/L的布比卡因,对照组注射同体积的生理盐水,由指定观察者对患者置换后的疼痛、吗啡用量、走动距离、膝关节最大活动度及疼痛目测类比评分进行比较。结果与结论：与对照组相比,试验组患者置换后疼痛目测类比评分降低,吗啡用量减少,不良事件减少,卧床时间较短,步行距离较长,关节活动度较大（P〈0.05~0.01）。提示单次神经传导阻滞联合神经康复治疗能够明显缓解全膝关节置换后患者的疼痛,促进其早期下床活动,减少住院天数。BACKGROUND：Continuous femoral nerve block is better than a simple analgesic treatment（morphine） during total knee replacement.Single-injection femoral nerve block does not require special equipment and expert management,and it is easy to operate and spends low cost.OBJECTIVE：To investigate the efficacy of single-injection femoral nerve block and neural rehabilitation to relieve pain and improve rehabilitation after total knee replacement.METHODS：A total of 40 patients were prospectively and randomly assigned to receive 40 mL of either 2.5 g/L bupivacaine（group B） or saline（group S） after total knee replacement.Blinded observers evaluated the patients for postoperative pain,morphine consumption,ambulating distances,and maximal knee flexion;pain was scored on the visual analog scale（VAS）.RESULTS AND CONCLUSION：Compared with group S patients,group B patients had significantly lower VAS pain scores in the postoperative anesthesia care unit（P 0.05-0.01）;group B patients also showed significantly lower total morphine use（P 0.05） and a lower incidence of morphine-related side effects.Significantly more group B than group S patients could ambulate on the day after surgery（P 0.05） and mean ambulatory distance was significantly better for group B than group S patients at discharge（P 0.01）.Knee flexion was significantly better for group B than group S patients on the second day after surgery（P 0.01）,but there was no significant difference between the two groups at discharge.Mean length of hospitalization was significantly shorter for group B than group S patients（P 0.05）.The single-injection femoral nerve block combined with neural rehabilitation can obviously relieve pain,facilitate early ambulation,and reduce the length of hospitalization in patients undergoing total knee replacement.

关 键 词：全膝关节置换 神经康复 股神经传导阻滞 单次 术后镇痛 

分 类 号：R318[医药卫生—生物医学工程]