股神经阻滞和收肌管阻滞对全膝关节置换术后镇痛及关节功能的影响

发布时间：2018-11-13 19:03

【摘要】：目的研究股神经阻滞和收肌管阻滞对全膝关节置换术(TKA)患者术后镇痛及关节功能的影响。方法选取我院关节外科需进行全膝关节置换的50例患者为研究对象,随机将其分为观察组和对照组,两组患者均在全麻下进行手术,术前20 min,观察组进行收肌管阻滞镇痛,对照组进行股神经阻滞镇痛。观察两组患者术前、术后(2、6、12、24、48h)疼痛评分,术前、术后股四头肌肌力和关节活动度并进行比较。结果两组患者术前静息痛、活动痛的VAS评分差异无统计学意义(P0.05),术后2、6、12、24、48h股神经阻滞组和收肌管阻滞组的静息痛、活动痛的VAS评分也差异无统计学意义(P0.05)。收肌管阻滞组患者术后24、48h股四头肌肌力明显优于股神经阻滞组(P0.05);术后72 h两组患者股四头肌肌力差异无统计学意义(P0.05);收肌管阻滞组患者在术后各时点上膝关节活动度明显大于股神经阻滞组患者(P0.05)。两组患者术中及术后均未出现明显严重的并发症。结论股神经阻滞和收肌管阻滞对TKA术后患者的镇痛作用差异不显著,但是收肌管阻滞患者股四头肌肌力和膝关节活动度恢复较股神经阻滞患者快,有利于患者早期进行功能锻炼和及早康复。
[Abstract]:Objective to study the effects of femoral nerve block and adductor canal block on postoperative analgesia and joint function in patients with total knee arthroplasty (TKA). Methods Fifty patients undergoing total knee arthroplasty in our hospital were randomly divided into two groups: the observation group and the control group. The two groups were all operated under general anesthesia, and 20 min, before operation, the observation group was treated with adductor block analgesia. The control group received femoral nerve block analgesia. The pain score before and after operation was observed and the muscle strength and joint motion of quadriceps femoris were compared before and after operation. Results there was no significant difference in VAS score between the two groups in preoperative resting pain and active pain (P0.05). There was no significant difference in VAS score of active pain (P0.05). The muscle strength of quadriceps femoris in adductor block group was significantly better than that in femoral nerve block group (P0.05), but there was no significant difference in quadriceps muscle strength between two groups at 72 hours after operation (P0.05). The knee joint motion in adductor canal block group was significantly higher than that in femoral nerve block group at each time point after operation (P0.05). There were no significant serious complications during and after operation in both groups. Conclusion there is no significant difference in analgesic effect between femoral nerve block and adductor canal block, but the recovery of quadriceps femoris muscle strength and knee joint activity in patients with adductor canal block is faster than that in patients with femoral nerve block. It is beneficial to early functional exercise and early recovery of patients.
【作者单位】：河南省洛阳正骨医院(河南省骨科医院)麻醉科;
【分类号】：R614

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