连续股神经阻滞对全膝关节置换术的镇痛及恢复效果  

Effect of Continuous Femoral Nerve Block and Periarticular Injection of Analgesic on the Early Functional Rehabilitation of the Knee after Total Knee Arthroplasty

作　　者：冯常武[1] 卢杰[1] 丁一[1] 张晓云[1] 张峰[1] 

机构地区：[1]湖北理工学院附属医院黄石市中心医院康复科,湖北黄石435000

出　　处：《现代生物医学进展》2015年第25期4905-4907,4865,共4页Progress in Modern Biomedicine

基　　金：国家自然科学基金项目(30872615)

摘　　要：目的:比较探究全膝关节置换术应用连续股神经阻滞与关节周围注射镇痛对全膝关节置换术镇痛疗效及对早期膝关节功能康复的影响。方法:选取我院行单侧膝全膝关节置换术的患者90例,随机分为连续股神经阻滞(CFNB)组和关节周围注射镇痛(LIA)组。CFNB组予以股神经周围泵入罗哌卡因镇痛,LIA组予以关节腔注射罗哌卡因+吗啡镇痛。分别于手术前后记录两组患者的疼痛评分(VAS)、股四头肌肌力评分,并评价患者的膝关节功能。结果:术后6 h、12 h,两组患者静息与活动状态下,VAS评分无明显差异;术后24 h、48 h,CFNB组患者在静息与活动状态下VAS评分均明显低于LIA组患者(P>0.05);第2 d-5 d,两组患者膝关节活动度比较,CFNB组明显优于LIA组(P<0.05),第6 d、7 d,两组膝关节活动度无明显差异(P>0.05);与LIA组比较,CFNB组患者完成主动直腿抬高实验时间明显较短(P<0.05)。两组患者股四头肌肌力评分比较无明显差异(P>0.05)。结论:连续股神经阻滞对全膝关节置换术的镇痛效果更明显,有助于早期膝关节功能恢复,且不影响股四头肌肌力。Objective： To explore the effect of continuous femoral nerve block and periarticular injection of analgesic on the functional rehabilitation of total knee arthroplasty. Methods： 90 cases of patients in our hospital underwent unilateral knee replacement surgery were divided into continuous femoral nerve block（CFNB） group and periarticular injection（LIA） group randomly. Group CFNB was treated with femoral nerve analgesia with ropivacaine infusion. Group LIA was treated with intra-articular injection of sodium chloride injection ＋ ropivacaine and morphine analgesia. Record the pain score（VAS）, biceps muscle strength score, evaluate the knee joint function before and after operation. Results： In the resting and active state, VAS score had no significant difference 6h and 12 h after operation. VAS score in CFNB groups were significantly lower than LIA group（P〈0.05） 24 h and 48 h after operation. To the knee joint activity, CFNB group is obviously higher than that of LIA group from 2 d-5 d after operation,（P〈0.05）, but no significance differences was detectd from 6 d-7 d after operation. Compared with LIA group, the straight leg raising test time form group CFNB completed was shorter（P〈0.05）. Conclusion： Continuous femoral nerve block analgesia is helpful to the analgesia and early recovery of patients with knee joint function, which would not affect the unit four biceps muscle.

关 键 词：全膝关节置换术 连续股神经阻滞 关节周围注射 镇痛 膝关节功能 

分 类 号：R687.4[医药卫生—骨科学]