持续收肌管阻滞对全膝关节置换术后早期活动的影响

The effect of continuous adductor canal blocks on early ambulation after total knee arthroplasty

目的评估持续收肌管阻滞对全膝关节置换术（total knee arthroplasty,TKA）后早期活动的影响。方法接受单侧TKA手术患者60例,男24例,女36例,年龄60~75岁,体重40~75kg,ASAⅡ或Ⅲ级。随机分为持续收肌管阻滞组（A组）和持续股神经阻滞组（F组）,每组30例。A组接受持续收肌管阻滞,F组接受持续股神经阻滞。记录TKA术后第1、2天每天总的步行距离,膝关节主动弯曲和伸直度,每日阿片类药使用量,疼痛评分及住院时间。结果 A组术后第1天和第2天步行距离分别为（36±5）m和（60±10）m,F组术后第1天和第2天步行距离分别为（4.5±3）m和（21±5）m,A组明显长于F组（P〈0.05）。A组术后第1天膝关节主动弯曲度大于F组（P〈0.05）。两组患者膝关节主动伸直度、每日阿片类药使用量、疼痛评分和住院时间等差异均无统计学意义。结论持续收肌管阻滞可促进TKA术后早期行走。

Objective To investigate the effect of continuous adductor canal blocks on early ambulation of patients after total knee arthroplasty（TKA）.Methods Sixty patients（male 24 cases,female 36 cases,aged 60-75 years,weighed 40-75 kg,ASA Ⅱ or Ⅲ grade）scheduled for unilateral TKA were randomly divided into two groups randomly,30 patients in each group.Patients in group A received continuous adductor canal blocks,patients in group F received continuous femoral blocks.Patient’s total ambulation distances,active range of knee flexion,knee extension,and the total daily opioid consumption on post operation day 1and 2in each group were recorded.Pain score and days of hospitalization in each group were also recorded.Results The ambulation distance on the first and the second day after operation of group A was higher than group F（P〈0.05）.Group A was（36±5）m on day 1and（60±10）m on day 2.Group F was（4.5±3）m on day 1and（21±5）m on day 2.There was no difference in motion range of the knee,pain score,total opioid consumption and the days of hospitalization between group A and group F.Conclusion Continuous adductor canal blocks can promote early ambulation after TKA.