股神经联合坐骨神经阻滞在全膝关节置换多模式镇痛中的应用  

Analgesic effect of femoral and sciatic nerve block under multimodal analgesia in total knee arthroplasty

作　　者：高维陆[1] 李鸿[1] 刘必全[1] 胡勇[1] 刘敬军[1] 尹力[1] 刘虎[2] 梅斌[2] 尹宗生[1] Gao Wei-lu Li Hong Liu Bi-quan Hu Yong Liu Jing-jun Yin Li Liu Hu Mei Bin Yin Zong-sheng(Department of Joint and Bone Tumor Surgery Department of Anesthesiology, the First Affiliated Hospital of Anhui Medical University, Hefei 230022, Anhui Province, China)

机构地区：[1]安徽医科大学第一附属医院关节与骨肿瘤外科,安徽省合肥市230022 [2]安徽医科大学第一附属医院麻醉科,安徽省合肥市230022

出　　处：《中国组织工程研究》2017年第19期2966-2972,共7页Chinese Journal of Tissue Engineering Research

摘　　要：背景:股神经阻滞在全膝关节置换术围手术期镇痛中的有效性得到广泛认可,但对于联合坐骨神经阻滞的必要性一直存在争议。目的:探讨股神经联合坐骨神经阻滞在全膝关节置换围手术期多模式镇痛中的镇痛效果及对功能锻炼的影响。方法:将150例拟行全膝关节置换的患者随机分为3组,每组50例。全麻组术前行常规全麻;股神经阻滞组在全麻前行术侧股神经阻滞;股神经+坐骨神经阻滞组在全麻前分别行术侧股神经、坐骨神经阻滞。比较3组患者术后静息、运动状态下的目测类比评分,膝关节主动活动度,术后住院天数,不良反应及复诊时的膝关节HSS评分。结果与结论:(1)股神经阻滞组、股神经+坐骨神经阻滞组术后各时间点静息、运动目测类比评分均显著低于全麻组(P<0.05),股神经+坐骨神经阻滞组显著低于股神经阻滞组(P<0.05);(2)股神经阻滞组、股神经+坐骨神经阻滞组术后各时间点膝关节主动活动度均显著大于全麻组(P<0.05),股神经+坐骨神经阻滞组显著大于股神经阻滞组(P<0.05);(3)股神经阻滞组、股神经+坐骨神经阻滞组术后住院天数均显著少于全麻组(P<0.05),股神经+坐骨神经阻滞组显著少于股神经阻滞组(P<0.05);(4)术后1个月时,股神经阻滞组、股神经+坐骨神经阻滞组的膝关节HSS评分均显著高于全麻组(P<0.05),股神经+坐骨神经阻滞组显著高于股神经阻滞组(P<0.05);术后3个月和6个月时,3组间的膝关节HSS评分差异无显著性意义(P>0.05);(5)结果提示,与全麻及股神经阻滞相比,股神经联合坐骨神经阻滞在全膝置换围手术期多模式镇痛中有更好的术后镇痛效果,为全膝关节置换患者术后早期功能锻炼提供了有利条件。BACKGROUND： The effectiveness of femoral nerve block in perioperative analgesia for total knee arthroplasty has been widely recognized, but the need for combined sciatic nerve block remains controversial.OBJECTIVE： To investigate the analgesic effect and rehabilitation training of femoral and sciatic nerve block in the perioperative period of total knee arthroplasty. METHODS： 150 patients undergoing total knee arthroplasty were randomly divided into three groups： general anesthesia, femoral nerve block and femoral and sciatic nerve block groups. The visual analogue scale scores at rest and in activity, range of motion of the knee, postoperative hospitalization time, adverse effects and the Hospital for Special Surgery scores were recorded and compared among groups.RESULTS AND CONCLUSION： （1） The order of visual analogue scale scores at rest and in activity at each time point postoperatively was as follows： general anesthesia group 〉 femoral nerve block group 〉 femoral and sciatic nerve block group （P 〈 0.05）. （2） The range of motion of the knee at different time points postoperatively was largest in the femoral nerve block group, followed by the femoral nerve block group, and smallest in the general anesthesia group （P 〈 0.05）. （3） The postoperative hospitalization time in the femoral nerve block and femoral and sciatic nerve block groups was significantly less than that in the general anesthesia group, and the time in the femoral and sciatic nerve block group was significantly less than that in the femoral nerve block group （P 〈 0.05）. （4） The Hospital for Special Surgery scores at 1 month postoperatively in the femoral nerve block and femoral and sciatic nerve block groups were significantly higher than those in the general anesthesia group, and the scores in the femoral and sciatic nerve block group were significantly higher than those in the femoral nerve block group （P 〈 0.05）. But the Hospital for Special Surgery knee scores at 3 and 6 months postopera

关 键 词：骨关节炎 膝 关节成形术 置换 膝 镇痛 组织工程 骨科植入物 人工假体 全膝关节置换 股神经阻滞 坐骨神经阻滞 多模式镇痛 视觉模拟评分 关节活动度 

分 类 号：R318[医药卫生—生物医学工程]