人工关节置换后镇痛:基于步态分析的神经阻滞

Analgesia following artificial joint replacement joint replacement: Nerve block based on gait analysis

背景:关节置换后镇痛目前多采用患者自控镇痛,但不良反应较多。连续外周神经阻滞镇痛虽安全、有效,但有可能因局部神经阻断出现局部麻木感而影响患者置换后的活动。目前应用步态分析方法评价关节置换后不同镇痛模式对患者置换后早期活动时步态的影响文献中尚未见报道。目的:比较连续外周神经阻滞(包括连续股神经阻滞和髂筋膜间隙阻滞)与单纯患者自控静脉镇痛用于全髋及全膝关节置换后对步态影响的差异。方法:采用0.5mfootscan?USB平板测试系统(比利时RSscanInternational公司)对17例受试者,其中7例为患者自控静脉镇痛,6例为连续股神经镇痛,4例为髂筋膜间隙镇痛。测试患者关节置换前后赤足自然行走时的步态并进行比较。结果与结论:连续股神经镇痛与自控静脉镇痛患者关节置换前后步态参数的改变差异无显著性意义(P>0.05),髂筋膜间隙阻滞镇痛患者关节置换前后步态参数的变化小于自控静脉镇痛患者(P<0.05)。从17例患者来看,髂筋膜间隙阻滞镇痛方法优于患者自控静脉镇痛,关节置换后股神经阻滞镇痛对步态的影响类似于患者自控静脉镇痛方法。

BACKGROUND： Analgesia following artificial joint repacement commonly utilizes patient-controlled method, which has many side effects. Continuous peripheral nerve block analgesia is safe and effective, but it may affect activity of patients following artificial joint repacement due to local numbness. Currently, studies are few regarding gait analysis used to evaluate effect of different analgesia methods on early activities of patients following artificial joint repacement. OBJECTIVE： To compare the effect of continuous nerve block （including femoral nerve block and fascia iliaca compartment block） and patient-controlled intravenous analgesia （PCIA） for postoperative pain control on gait after total hip and knee replacement. METHODS： A total of 17 volunteer subjects were selected including 7 injected with PCIA after operation, 6 with femoral nerve block and 4 with fascia iliaca compartment block. Subjects were asked to walk at their own paces with barefoot on a 10 m walkway with a 0.5m footscan plate （footscan from RSscan International, Olen, Belgium）. Barefoot walking gaits were compared before and after replacement. RESULTS AND CONCLUSION： There were no significant differences between continuous nerve block and PCIA for postoperative pain control in the parameters （P 0.05）. The parameter changes in patients undergoing fascia iliaca compartment block were less than PCIA patients （P 0.05）. Of 17 patients, effects of fascia iliaca compartment block were superior over PCIA, and femoral nerve block was similar to PCIA following artificial joint replacement.