坐骨神经阻滞联合持续股神经阻滞或持续收肌管阻滞对人工全膝关节置换术后疼痛与运动功能影响的比较研究  

Comparison of the effects of sciatic nerve block combined with continuted femoral nerve block or continuted adductor canal block on pain and motor function after total knee arthroplasty

作　　者：朱光 邹丽丽[2] 金群华[3,4] ZHU Guang;ZOU Lili;JIN Qunhua(School of Clinical Medicine,Ningxia Medical University,Yinchuan Ningxia,750001,P.R.China;Department of Anesthesiology,General Hospital of Ningxia Medical University,Yinchuan Ningxia,750001,P.R.China;Ningxia Institute of Osteoarthropathy,General Hospital of Ningxia Medical University,Yinchuan Ningxia,750001,P.R.China;Ningxia Institute of Medical Sciences,Ningxia Medical University,Yinchuan Ningxia,750001,P.R.China)

机构地区：[1]宁夏医科大学临床医学院,银川750001 [2]宁夏医科大学总医院麻醉科,银川750001 [3]宁夏医科大学总医院宁夏骨关节炎(病)研究所,银川750001 [4]宁夏医科大学宁夏医学科学研究所,银川750001

出　　处：《中国修复重建外科杂志》2024年第5期556-561,共6页Chinese Journal of Reparative and Reconstructive Surgery

基　　金：宁夏医科大学总医院“医工专项”(NYZYYG-001);宁夏回族自治区重大科技成果转化项目(2023CJE09037);宁夏医科大学校级课题(XZ2020014)。

摘　　要：目的比较坐骨神经阻滞(sciatic nerve block,SNB)联合持续股神经阻滞(femoral nerve block,FNB)或持续收肌管阻滞(adductor canal block,ACB)对人工全膝关节置换术(total knee arthroplasty,TKA)术后疼痛和运动功能的影响。方法共纳入2020年12月—2021年2月收治且符合选择标准的60例行TKA治疗的膝关节骨关节炎患者,随机分为研究组(SNB联合持续ACB)和对照组(SNB联合持续FNB),每组30例。两组患者性别、年龄、体质量、身高、身体质量指数及术前膝关节美国特种外科医院(HSS)评分、胫股角、胫骨近端内侧角等基线资料比较差异均无统计学意义(P>0.05)。记录手术时间、初次下地时间、初次行走距离、术后住院时间;术后2、4、6、12、24、48 h,采用数字评分量表(NRS)评价患者膝关节周围静息疼痛情况,采用徒手肌力法评价股四头肌肌力变化,并测量膝关节屈曲及伸直角度。结果两组患者手术时间和初次行走距离比较差异无统计学意义(P>0.05);研究组初次下地时间和术后住院时间均明显短于对照组,差异有统计学意义(P<0.05)。除术后48 h研究组NRS评分低于对照组(P<0.05)外,其余时间点两组NRS评分比较差异无统计学意义(P>0.05)。术后4~24 h研究组股四头肌肌力及2~6 h膝关节伸直角度均优于对照组,差异有统计学意义(P<0.05);其余时间点两组股四头肌肌力和膝关节屈伸角度比较差异均无统计学意义(P>0.05)。结论SNB联合持续ACB或持续FNB均可有效缓解TKA术后患者疼痛,与联合持续FNB相比,联合持续ACB对股四头肌肌力影响更小,患者膝关节屈伸活动恢复更好。Objective To compare the effect of sciatic nerve block(SNB)combined with continuted femoral nerve block(FNB)or continuted adductor canal block(ACB)on pain and motor function after total knee arthroplasty(TKA).Methods A total of 60 patients with TKA-treated osteoarthritis of the knee who met the selection criteria were enrolled between November 2020 and February 2021 and randomised allocated into the study group(SNB combined with continuted ACB)and the control group(SNB combined with continuted FNB),with 30 cases in each group.There was no significant difference in gender,age,body mass,height,body mass index,preoperative Hospital for Special Surgery(HSS)score,femoral tibial angle,and medial proximal tibial angle between the two groups(P>0.05).The operation time,the initial time to the ground,the initial walking distance,and the postoperative hospital stay were recorded.At 2,4,6,12,24,and 48 hours after operation,the numerical rating scale(NRS)score was used to evaluate the rest pain around the knee joint,the quadriceps femoris muscle strength was evaluated by the freehand muscle strength method,and the knee flexion and extension angles were measured.Results There was no significant difference in the operation time and initial walking distance between the two groups(P>0.05);the initial time to the ground and postoperative hospital stay of the study group were significantly shorter than those of the control group(P<0.05).Except for the 48-hour postoperative NRS score of the study group,which was significantly lower than that of the control group(P<0.05),there was no significant difference in the NRS scores between the two groups at the remaining time points(P>0.05).The quadriceps femoris muscle strength from 4 to 24 hours postoperatively and the knee extension angle from 2 to 6 hours postoperatively of the study group were significantly better than those of the control group(P<0.05);the differences in the quadriceps femoris muscle strength and knee extension and flexion angles between the two groups at the remaining

关 键 词：人工全膝关节置换术 坐骨神经阻滞 股神经阻滞 收肌管阻滞 

分 类 号：R687.4[医药卫生—骨科学]