全髋关节置换两种神经阻滞术后镇痛效果比较  

Comparison of analgesic effect of two kinds of nerve block in total hip arthroplasty

作　　者：王雷[1] 朱炬[1] 王承群 刘庆宽[1] 张元民[1] WANG Lei;ZHU Ju;WANG Cheng-qun;LIU Qing-kuan;ZHANG Yuan-min(Department of Bone and Joint Surgery,Affiliated Hospital,Jining Medical College,Jining 272001,China)

机构地区：[1]济宁医学院附属医院骨关节科,山东济宁272001

出　　处：《中国矫形外科杂志》2021年第21期1995-1997,共3页Orthopedic Journal of China

摘　　要：[目的]比较两种神经阻滞在直接前路全髋关节置换术后镇痛效果。[方法]2019年6月—2020年6月,将本院骨科经直接前入路全髋置换的67例患者纳入本研究,随机分为2组,其中,34例采用髋关节囊周神经阻滞(pericapsular nerve block,PNB),33例采用腰方肌阻滞(quadratus lumborum block,QLB)。观察两组围手术期镇痛效果。[结果]PNB组的神经穿刺时间显著长于QLB组(P<0.05),两组一次穿刺成功率的差异无统计学意义(P>0.05),PNB组闭孔神经、股神经的阻滞区域评级显著优于QLB组(P<0.05)。随术后时间推移,两组VAS评分显著下降(P<0.05),但自控静脉镇痛按压泵(patient-con⁃trolled intravenous analgesia,PCIA)按压次数显著增加(P<0.05)。术后6~18 h,PNB组的VAS评分和PCIA按压次数均显著小于QLB组(P<0.05),术后24 h,两组间差异无统计学意义(P>0.05)。[结论]直接前路全髋关节置换PNB阻滞的镇痛效果优于QLB阻滞。[Objective]To compare the analgesic effects of two nerve blocks in total hip arthroplasty through the direct anterior ap⁃proach.[Methods]From June 2019 to June 2020,67 patients who were undergoing total hip arthroplasty(THA)through direct anterior ap⁃proach(DAA)in our hospital were included in this study,and randomly divided into 2 groups.Of them,34 patients received pericapsular nerve block(PNB),while the remaining 33 patients received quadratus lumborum block(QLB)in THA.The analgesic effect during the peri⁃operative period were compared between the two groups.[Results]Although the PNB group consumed significantly longer time in puncture than the QLB group(P<0.05),there was no significant difference in the success rate of puncture in the first time between the two groups(P>0.05).The PNB group was significantly superior to the QLB group in term of blocking efficiency in area of the obturator nerve and femoral nerve than the QLB group(P<0.05).As time went after operation,the VAS scores decreased significantly(P<0.05),while the number of PCIA compressions increased significantly in both groups(P<0.05).From 6 to 18 hours after operation,the PNB group had significantly less VAS and PCIA than the QLB group(P<0.05),regardless of that no significant differences were noted between the two groups at 24 hours af⁃ter operation(P>0.05).[Conclusion]The PNB is considerably better than QLB in term of analgesic effect in THA through DAA approach.

关 键 词：全髋关节置换术 直接前路 囊周围神经阻滞 腰方肌神经阻滞 

分 类 号：R687.4[医药卫生—骨科学]