超声引导下两种入路坐骨神经阻滞对于踝部骨折患者麻醉效果的比较  

Comparison of ultrasound-guided sciatic nerve block through greater trochanter approach and popliteal approach in patients with lower limb fractures

作　　者：谢振玮[1] 姚军[1] XIE Zhenwei; YAO Jun(Deportment of Anesthesiology, Shanghai Sixth People＇s Hospital, Shanghai Jiaotong University, Shanghai 200233, China)

机构地区：[1]上海交通大学附属第六人民医院麻醉科,上海200233

出　　处：《上海医学》2018年第9期537-540,共4页Shanghai Medical Journal

摘　　要：目的比较超声引导下股骨大转子平面入路和腘窝上入路坐骨神经阻滞用于外踝、跟骨和足外侧骨折患者麻醉的效果。方法选择择期行外踝、跟骨和足外侧骨折切开复位内固定术的患者50例,随机分为超声引导下股骨大转子平面入路组(GTA组)和腘窝上入路组(PA组),每组25例。分别在坐骨神经阻滞后行全身麻醉,记录并比较两组患者的感觉阻滞起效时间、神经阻滞操作时长、坐骨神经深度、术中芬太尼用量,以及术后8h疼痛VAS评分和股后肌群肌力。结果 PA组患者的感觉阻滞起效时间显著快于GTA组,神经阻滞操作时长显著短于GTA组,坐骨神经深度显著浅于GTA组(P值均<0.01)。两组间术中芬太尼用量和术后8h疼痛VAS评分的差异均无统计学意义(P值均>0.05)。PA组术后8h的股后肌群肌力均达到Ⅳ或Ⅴ级,而GTA组仅2例肌力达到Ⅲ级,其余均低于Ⅲ级,两组间肌力Ⅲ级及以上和肌力Ⅲ级以下患者构成的差异均有统计学意义(P值均<0.01)。结论腘窝上入路坐骨神经阻滞相比股骨大转子入路操作便捷,且能更好地保留股后肌群肌力,两种方法的镇痛效果相当。Objective To compare the effect of ultrasound-guided sciatic nerve block between the greater trochanter approach （GTA） and popliteal approach （PA） in patients with malleolus, calcaneal and lateral foot fractures. Methods Fifty patients with malleolus, calcaneal and lateral foot fractures scheduled for open reduction and internal fixation were enrolled into this study. They were randomized to receive either GTA or PA ultrasound-guided sciatic nerve block before general anesthesia. There were 25 patients in each group. The onset time of sensory block, nerve block duration, sciatic nerve depth, fentanyl consumption, hamstrings muscle strength and visual analogue scale（VAS） score at 8 h after operation were recorded. Results The onset time of sensory block and nerve block duration of PA group were significantly shorter than those of GTA group, while the sciatic nerve depth of PA group was significantly shallower than that of GTA group （all P〈0. 01）. There was no significant difference in the dosage of fentanyl or the VAS at 8 h after operation between the two groups （both P〉 0.05）. The muscular strength of hamstrings recovered grade ≥Ⅲ in PA group, while the muscle strength was up to grade Ⅲ only in 2 cases in GTA group and the rest were lower than grade Ⅲ （both P〈0.01）. Conclusion The popliteal approach sciatic nerve block is more convenient and easier than the greater trochanter approach, also superior in preserving hamstrings muscle strength, without a significant difference in analgesic effect.

关 键 词：超声引导 坐骨神经阻滞 股骨大转子入路 胭窝上入路 

分 类 号：R614[医药卫生—麻醉学]