收肌管阻滞联合膝关节后方浸润在前交叉韧带重建术后的作用

The Function of Adductor Canal Block Combined with Posterior Knee Infiltration in Postoperative Rehabilitation after Arthroscopic Reconstruction of Anterior Cruciate Ligament

目的:探讨超声引导下收肌管阻滞联合膝关节后方浸润在膝关节镜下前交叉韧带重建术术后的镇痛作用和早期的康复作用。方法:行膝关节镜下前交叉韧带重建术患者60例,随机均分为收肌管阻滞联合膝关节后方浸润组(A组,0.375%罗哌卡因30 m L进行收肌管阻滞、0.2%罗哌卡因50 m L进行膝关节后方浸润)和对照组(B组,0.9%生理盐水30 m L进行收肌管阻滞、0.9%生理盐水50 m L膝关节后方浸润),观察2组患者术后2、4、8、24及48 h膝关节的静息时和活动时视觉模拟疼痛评分(VAS),比较2组患者术后24 h和48 h的膝关节活动度及患肢首次行主动直腿抬高时间及术后使用镇痛药物的不良反应。结果:术后2、4、8、24及48 h,A组患者的静息痛、活动痛VAS评分低于B组、主动膝关节活动度优于B组(P<0.05或P<0.01);2组患者均在术后早期能够进行直腿抬高锻炼,但首次直腿抬高时间比较,差异无统计学意义(P=0.077)。结论:超声引导下收肌管阻滞联合膝关节后方浸润可以为膝关节镜前交叉韧带手术患者提供良好的术后镇痛效果及术后康复。

Objective： To investigate the function of uhrasound-guided adductor canal block com bined with posterior knee infiltration in the postoperative analgesia and early postoperative rehabilitation after arthroseopic anterior cruciate ligament reconstruction operation. Methods： 60 patients who underwent arthroscopic reconstruction of anterior cruciate ligament （ACL） were chosen and randomly divided into two groups： adductor canal block combined with posterior knee infiltration group （group A, adductor canal block with 0. 375% ropivacaine 30 mL, posterior knee infiltration with 0. 375% ropivacaine 50 mL） and control group （group B, adductor canal block with O. 9% NS 30 mL, posterior knee infiltration with 0.9% NS 50 mL）, 30 cases in each group. 2 h,4 h,8 h,24 h,48 h after operation, rest pain and active pain scores of knee joint in two groups were observed and compared. The activity of the knee joint was recorded 24 h and 48 h after operation, first straight leg raising time was recorded and adverse drug reactions of analgesic drugs were also compared between two groups. Results： There were statistically differences between group A and group B in the rest pain and active pain scores 2 h, 4 h,8 h,24 h,48 h after operation（P 〈0.05 or P 〈0.01 ）. The activity of knee joint was significantly higher in group A than that in group B 24 h and 48 h after operation （ P 〈 0.05）. There was no significant difference between group A and group B in the first straight leg raising time （ P = 0. 077 ）. Conlusion： Patient undergoing ultrasound-guided adductor canal block combined with posterior knee infiltration in the anterior cruciate ligament surgery can get good analgesic effect and better early postopera- tive rehabilitation.