肌间沟颈臂丛神经阻滞在肱骨外科颈骨折术中的应用

Application of interscalene cervicobrachial plexus block to operation of humeral surgical neck fracture

目的比较肌间沟臂丛阻滞和肌间沟颈臂丛阻滞在肱骨外科颈骨折手术中的麻醉效果。方法将62例肱骨外科颈骨折手术患者，按随机数字表法分为A、B两组，每组31例。A组于肌间沟C6横突水平与皮肤垂直进针，出现异感时注入1％利多卡因＋0．25％罗哌卡因混合液25ml（内含1：20万肾上腺素）；B组穿刺点分别为肌间沟C4、C6横突水平，同上方法分别注入上述麻药10，15ml。据患者主诉和骨科医师评定阻滞效果，分Ⅰ-Ⅲ级。结果B组中Ⅰ级的发生率高于A组（P〈0．01），而Ⅲ级的发生率低于A组（P〈0．01）。两组不良反应的发生率比较差异无统计学意义（P〉0．05）。结论对于肱骨外科颈骨折手术，肌间沟颈臂丛阻滞的麻醉效果明显优于肌间沟臂丛阻滞法。

Objective To compare the anesthetic effects of interscalene brachial plexus block and interscalene cervicobrachial plex- us block in the operation of humeral surgical neck fracture. Methods Sixty-two patients scheduled for operation of humeral surgical neck fracture were divided into Group A and Group B （n = 31/group） according to randomized digital table. The needle was in- serted perpendicularly into the skin at the level of the transverse process of C6 through interscalene approach. When a paresthesia was elicited, 25 ml of the mixture of 1% Lidocaine and 0.25 % Ropivaeaine （ with 1：200,000 epinephrine） was injected in Group A. With the same method in Group A, 10 ml and 15 ml of the above mixture was injected respectively at the level of the transverse process of C4 and C6 in Group B. The block effects were graded into Ⅰ,Ⅱ and Ⅲ , based on the evaluation by patient＇ s chief complaints and orthopedists. Results The incidence of grade Ⅰ was significantly higher in Group B than in Group A （ P 〈 0.01 ） , and that of grade Ⅲ was significantly lower in Group B than in Group A （ P 〈 0.01 ）. There was no significant difference in the incidence of adverse reactions between two groups （P 〉 0.05）. Conclusion The anesthesia with interscalene cervicobrachial plexus block is more effective than that with intersealene brachial plexus block in the operation of humeral surgical neck fracture.