连续股神经阻滞联合关节周围浸润镇痛对全膝关节置换术后关节早期功能恢复的影响

发布时间：2018-10-21 18:22

【摘要】：目的:比较连续股神经阻滞(continuous femoral nerve block,CFNB)和CFNB联合关节周围浸润镇痛(periarticular local infiltration analgesia,PLIA)对膝关节置换术后镇痛及早期功能恢复的影响。方法:选择择期行膝关节置换手术患者100例,随机分为CFNB组(n=50)和CFNB联合PLIA组(简称PLIA组,n=50),以视觉模拟评分(visual analogue score,VAS)评价患者疼痛程度,在术后各时点记录静息及被动运动时患侧膝关节前、后部VAS评分。记录术后患者被动屈膝90°时间、主动直腿抬高时间,记录患者术前及术后72 h美国特种外科医院膝关节评分(hospital for special surgery knee score,HSS)。结果:术后静息时膝关节前部VAS评分在各时点两组间差异均无统计学意义(P0.05),但膝关节后部VAS评分在术后4、8、12、24 h时PLIA组明显低于CFNB组(P0.05)。被动运动时PLIA组膝关节前部VAS评分在术后24 h明显低于CFNB组(P0.05),膝关节后部VAS评分在术后12、24 h明显低于CFNB组(P0.05)。两组术前及术后72 h HSS评分差异无统计学意义(P0.05)。与CFNB组比较,PLIA组被动屈膝90°时间和主动直腿抬高时间均明显缩短(P0.05)。结论:CFNB联合PLIA镇痛可以降低术后膝关节后部疼痛评分,减少被动运动疼痛,缩短被动屈膝90°时间,改善患者术后早期康复效果。
[Abstract]:Aim: to compare the effects of continuous femoral nerve block (continuous femoral nerve block,CFNB) and CFNB combined with periarticular infiltration analgesia (periarticular local infiltration analgesia,PLIA) on analgesia and early functional recovery after knee arthroplasty. Methods: 100 patients undergoing knee arthroplasty were randomly divided into CFNB group (n = 50) and CFNB combined with PLIA group (PLIA group, n = 50). The degree of pain was evaluated by visual analogue score (visual analogue score,VAS). The VAS scores of anterior and posterior knee joints were recorded at different time points after operation. The time of passive flexion 90 掳and active straight leg elevation were recorded. The knee joint score (hospital for special surgery knee score,HSS) was recorded before and 72 hours after operation in the United States Special surgery Hospital. Results: there was no significant difference between the two groups in the VAS score of the anterior part of the knee joint at each time point (P0.05), but the VAS score of the posterior part of the knee joint was significantly lower in the PLIA group than in the CFNB group at 24 hours after the operation (P0.05). The VAS score of anterior knee in PLIA group was significantly lower than that in CFNB group at 24 h after passive movement (P0.05), and the VAS score in posterior knee joint was significantly lower than that in CFNB group at 24 h after operation (P0.05). There was no significant difference in HSS score between the two groups before and 72 hours after operation (P0.05). Compared with CFNB group, the time of passive flexion 90 掳and active straight leg elevation in PLIA group were significantly shortened (P0.05). Conclusion: CFNB combined with PLIA analgesia can reduce postoperative pain score of posterior knee joint, reduce passive motion pain, shorten 90 掳time of passive flexion, and improve early rehabilitation effect of postoperative patients.
【作者单位】：北京大学第三医院麻醉科;
【分类号】：R614

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