超声引导下收肌管阻滞复合不同入路坐骨神经阻滞应用于老年单侧TKA术后镇痛中的效果  

Effect of Ultrasound-guided Adductor Canal Block Combined with Different Approaches for Sciatic Nerve Block in Elderly Patients with Postoperative Analgesia Undergoing Unilateral TKA

作　　者：侯杰 叶碧 陈碧虹 李景云 谭艳华 邹素娟 HOU Jie;YE Bi;CHEN Bihong;LI Jingyun;TAN Yanhua;ZOU Sujuan(Shenzhen Pingshan District People’s Hospital,Guangdong Province,Shenzhen 518118,China;不详)

机构地区：[1]广东省深圳市坪山区人民医院,广东深圳518118

出　　处：《中国医学创新》2022年第16期5-9,共5页Medical Innovation of China

基　　金：深圳市坪山区卫生健康系统科研项目(202063)。

摘　　要：目的:探讨超声引导下收肌管阻滞(ACB)复合不同入路坐骨神经阻滞(SNB)应用于老年单侧膝关节置换术(TKA)术后镇痛中的效果。方法:选取:2018年3月-2021年9月深圳市坪山区人民医院行单侧TKA术的60例老年患者,按照随机数字表法将其分为C组和O组,各30例。所有患者TKA术中采取腰硬联合麻醉,在术后采用超声引导下ACB复合SNB镇痛,C组行大转子下外侧入路,O组行腘窝上外侧入路。对比两组阻滞情况相关指标、不同时间点的疼痛程度、股四头肌肌力、膝关节活动度。结果:O组的阻滞操作完成时间短于C组,超声成像清晰度评分、45 min阻滞成功率均高于C组,穿刺针深度小于C组(P<0.05);两组阻滞起效时间比较,差异无统计学意义(P>0.05)。两组不同时间点的视觉模拟评分法(visual analogue scale,VAS)评分比较,差异均无统计学意义(P>0.05)。O组术后24、48 h的股四头肌肌力均大于C组(P<0.05);两组术后72 h的股四头肌肌力比较,差异无统计学意义(P>0.05)。O组术后24、48 h的膝关节活动度均大于C组(P<0.05);两组术后72 h的膝关节活动度比较,差异无统计学意义(P>0.05)。结论:超声引导下ACB复合大转子下外侧入路或腘窝上外侧入路行SNB应用于老年患者单侧TKA术后镇痛均能有效发挥阻滞作用,缓解患者术后不同时间点的疼痛,但腘窝上外侧入路的阻滞操作时间更短,45 min阻滞成功率更高,超声成像清晰度更好,且对患者术后膝关节活动和股四头肌肌力的影响更小。Objective:To investigate the effect of ultrasound-guided adductor canal block(ACB) combined with different approaches of sciatic nerve block(SNB) in postoperative analgesia in elderly patients underwent unilateral knee arthroplasty(TKA).Method:A total of 60 elderly patients underwent unilateral TKA in Shenzhen Pingshan District People’s Hospital from March 2018 to September 2021 were selected,and they were divided into the group C and the group O according to the random number table method,with 30 cases in each group.All patients received combined spinal-epidural anesthesia during TKA,and ultrasound-guided ACB combined with SNB analgesia was used postoperatively.The group C was given the SNB via the inferior trochanteric approach,and the group O was given the SNB via the superior and lateral popliteal fossa approach.The indexes related to block,pain at different time points,quadriceps muscle strength,and knee joint activity were compared between the two groups.Result:The completion time of blocking operation in group O was shorter than that in group C,the ultrasound imaging clarity score and the blocking success rate of 45 min were higher than those in group C,and the needle depth was smaller than that in group C(P<0.05).There was no significant difference in the onset time of block between the two groups(P>0.05).There were no significant differences in visual analogue scale(VAS) scores between the two groups at different time points(P>0.05).The quadriceps muscle strength in group O were higher than those in group C at 24 and 48 h after operation(P<0.05).There was no significant difference in the quadriceps muscle strength between the two groups at 72 h after surgery(P>0.05).The knee motion of group O were higher than those of group C at 24 and 48 h after operation(P<0.05).There was no significant difference in knee motion 72 h after operation between the two groups(P>0.05).Conclusion:Ultrasound-guided ACB combined with inferior trochanteric approach into the road or on the lateral popliteal fossa approach SNB

关 键 词：臀下间隙 腘窝上外侧 ACB SNB 

分 类 号：R614[医药卫生—麻醉学]