超声引导下髋关节注射与髂筋膜间隙阻滞在老年髋部骨折术前镇痛中的效果比较  

Comparison of ultrasound‑guided hip joint injection and fascia iliaca compartment block in preoperative analgesia of elderly hip fractures

作　　者：张志梅[1] 宋永波 刘采采 潘龙 刘振国[1] Zhang Zhimei;Song Yongbo;Liu Caicai;Pan Long;Liu Zhenguo(Department of Anesthesiology,Weifang People's Hospital,Weifang 261000,China;Department of Anesthesiology,Weifang Brain Hospi-tal,Weifang 261012,China)

机构地区：[1]潍坊市人民医院麻醉科,潍坊261000 [2]潍坊市脑科医院麻醉科,潍坊261012

出　　处：《国际麻醉学与复苏杂志》2022年第11期1163-1167,共5页International Journal of Anesthesiology and Resuscitation

基　　金：潍坊市卫生健康委员会课题(WFWSJK-2021-304)。

摘　　要：目的比较超声引导下髋关节注射(hip injection,HI)与髂筋膜间隙阻滞(fascia iliaca compartment block,FICB)应用罗哌卡因在老年髋部骨折术前镇痛中的镇痛效果。方法选择髋关节囊内骨折行单侧髋关节置换术的老年患者60例,性别不限,年龄65~80岁,ASA分级Ⅱ、Ⅲ级,BMI 18~25 kg/m^(2)。采用随机数字表法将患者分为两组:试验组(HI组)和对照组(FICB组),每组30例。HI组:超声探头平行股骨颈,识别髂股韧带,将罗哌卡因注射到关节腔和转子囊之间。FICB组:超声引导下识别"山坡征",识别腹横肌、髂肌、髂筋膜,将罗哌卡因注射到髂筋膜下。记录两组患者一般情况,评估区域麻醉前(T_(0))、区域麻醉后20 min(T_(1))、区域麻醉后12 h(T_(2))、区域麻醉后24 h(T_(3))、区域麻醉后48 h(T_(4))静息和运动VAS疼痛评分,记录T_(1)~T_(4)时被动屈髋角度及两组并发症发生情况。结果两组一般情况差异无统计学意义(P>0.05)。HI组T_(1)~T_(4)时静息和运动VAS疼痛评分低于T_(0)时(P均<0.05),FICB组T_(1)~T_(4)时静息和运动VAS疼痛评分低于T_(0)时(P均<0.05)。与FICB组比较,HI组T_(1)~T_(4)时运动VAS疼痛评分降低(P均<0.05),HI组T_(1)~T_(4)时被动屈髋角度增加(P均<0.05)。两组并发症发生情况差异无统计学意义(P>0.05)。结论HI对于髋关节囊内骨折患者术前镇痛效果优于FICB,其对于运动疼痛的镇痛效果更好。Objective To compare the analgesic effects of ultrasound‑guided hip joint injection(HI)and fascia iliaca compartment block(FICB)of ropivacaine in preoperative analgesia of elderly patients hip fractures,so as to provide basis for optimizing preoperative analgesia of hip fractures.Methods Sixty elderly patients with intracapsular hip fractures undergoing unilateral hip arthroplasty,regardless of gender,aged 65−80 years,ASA gradeⅡ−Ⅲ,BMI 18−25 kg/m^(2),were divided into experimental group(HI group)and control group(FICB group)by random number table method,with 30 cases in each group.HI group:ultrasound parallels the femoral neck,identifies the iliofemoral ligament,and injects the ropivacaine between the joint cavity and the trochanter capsule.FICB group:using ultrasound to identify the"hillside sign",transversus abdominal muscle,iliac muscle and lilac fascia,and injects the ropivacaine under the iliac fascia.The following data of patients were recorded:general conditions.Resting and motor Visual Analogue Scale(VAS)scores before regional anesthesia(T_(0)),20 min after regional anesthesia(T_(1)),12 h after regional anesthesia(T_(2)),24 h after regional anesthesia(T_(3)),48 h after regional anesthesia(T_(4)).Passive hip flexion angle from T_(1)to T_(4)and the occurrence of complication in the two groups.Results The general conditions between the patients in two groups did not show significant difference(P>0.05).The VAS scores of resting and motor in HI group from T_(1)to T_(4)were lower than T_(0)(All P<0.05).The VAS scores of resting and motor in FICB group from T_(1)to T_(4)were lower than T_(0)(All P<0.05).Compared with FICB group,the motor VAS score of T_(1)−T_(4)in HI group decreased(All P<0.05),T_(1)−T_(4)passive hip flexion angle was increased(All P<0.05).There was no significant difference in complication between the two groups(P>0.05).Conclusions The analgesic effect of HI is better than FICB in patients with hip joint intracapsular fracture,and it is better for dynamic pain.

关 键 词：髋部骨折 术前镇痛 髋关节注射 髂筋膜间隙阻滞 

分 类 号：R614[医药卫生—麻醉学]