胫骨高位截骨术后超声引导下收肌管阻滞镇痛  

Ultrasound-guided adductor tube block for pain management after open wedge high tibia osteotomy

作　　者：高智慧[1] 张帅[1] 李鹏[1] 郭浩辉[1] 庞龙[1] 金群华[1] GAO Zhihui;ZHANG Shuai;LI Peng;GUO Hao-hui;PANG Long;JIN Qun-hua(The Third Department of Orthopaedics,General Hospital,Ningxia Medical University,Yinchuan 750004,China)

机构地区：[1]宁夏医科大学总医院骨三科

出　　处：《中国矫形外科杂志》2019年第23期2143-2147,共5页Orthopedic Journal of China

基　　金：宁夏回族自治区卫生计生委重点研究课题（编号：2017-NW-005）;宁夏医科大学科学研究基金资助项目（编号：XZ2017012）

摘　　要：[目的]评估超声引导下收肌管阻滞用于开放楔形胫骨高位截骨术术后镇痛的效果。[方法]纳入拟行单侧开放楔形胫骨高位截骨术的患者60例。随机分为两组,每组30例,分别给予收肌管阻滞镇痛和传统疼痛处理。记录两组患者静息和活动状态下VAS评分,盐酸哌替啶的使用次数、不良反应发生情况及并发症情况。[结果]阻滞组患者术后6 h的静息VAS评分最低,而术后12、24、48、72 h静息VAS评分无显著变化;而传统组术后6 h的VAS评分最高,随时间推移VAS评分逐渐降低;术后48、72 h下地行部分负重功能锻炼时术区疼痛的VAS评分显著高于静息状态。术后6、12、24和48 h卧床休息状态,阻滞组静息VAS评分显著小于传统组,差异有统计学意义(P<0.05);术后72 h时,阻滞组静息VAS评分仍小于传统组,但差异已无统计学意义(P<0.05)术后48h下地行部分负重功能锻炼时,阻滞组的活动VAS显著低于传统组,差异有统计学意义(P>0.005):术后72h阻滞组的活动VAS仍低于传统组,差异无统计学意义(P>0.005)。阻滞组肌肉注射盐酸哌替啶4例,而传统组为9例,差异有统计学意义(P<0.005)。[结论]超声引导下收肌管阻滞用于开放楔形胫骨高位截骨术术后镇痛效果良好,并可减少盐酸哌替啶使用次数。[Objective]To evaluate the analgesic efficacy of ultrasound-guided adductor canal block after open wedge high tibial osteotomy.[Methods]Sixty patients who underwent unilateral open wedge high tibial osteotomy were included in the study,and randomly divided into two groups with 30 patients in each group.The patients in the block group received ultrasound-guided adductor canal block for pain management,while those in the traditional group had conventional pain management.The visual analogue scale(VAS)for pain at rest and activity,additional uses of pethidine hydrochloric acid,adverse reaction and complications were compared between the two group.[Results]The VAS score at rest at 6 hours in the block group proved the lowest,which slightly increased and then remained unchanged remarkably from 12 hours to 72 hours.By contrast,the VAS score at rest in the traditional group was the highest at 6 hours,and decreased over time.After ambulation at 48 and 72 hours postoperatively,the VAS scores at activity were considerably higher than those at rest in both groups.The block group was marked lower VAS score at rest than the traditional group,which proved statistically significant at 6,12,24 and 48 hours(P<0.05),whereas insignificant at 72 hours postoperatively(P>0.05).In addition,the block group also got lower VAS score at activity than the traditional group,which proved statistically significant at 48 hours(P<0.05),and became insignificant at 72 hours after operation(P>0.05).Additional usage of pethidine hydrochloric acid was noticed in 4 patients of the block group,while 9 patients in the traditional group,which was statistically significant(P<0.05).[Conclusion]The ultrasound-guided adductor canal block does provide satisfactory analgesic effect,and reduce usage of pethidine hydrochloric acid after open wedge high tibia osteotomy.

关 键 词：膝关节 骨关节炎 胫骨高位截骨术 收肌管阻滞 

分 类 号：R687[医药卫生—骨科学]