全膝关节置换术患者术后股神经阻滞和收肌管阻滞的比较

Comparison of postoperative analgesia effects between femoral nerve block and adductor canal block in TKA patients

目的研究股神经阻滞和收肌管阻滞对TKA患者术后镇痛作用及对运动的影响。方法选取本院关节外科需进行全膝关节置换的50例患者为研究对象,将其随机分为实验组和对照组,实验组进行收肌管阻滞镇痛,对照组进行股神经阻滞镇痛。观察2组患者术前、术后(2 h、6 h、12 h、24 h、48 h)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 2组患者术前静息痛、活动痛的VAS评分无明显差异(P>0.05),术后2 h、6 h、12 h、24 h、4 8h,2组患者的静息痛、活动痛的VAS评分差异无统计学意义(P>0.05)。收肌管阻滞组患者术后24 h、48 h股四头肌肌力明显优于股神经阻滞组,差异有统计学意义(P<0.05);术后72 h,2组患者股四头肌肌力差异无统计学意义(P>0.05);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,差异有统计学意义(P<0.05)。结论股神经阻滞和收肌管阻滞对TKA患者术后的镇痛作用差异无统计学意义,但是对收肌管阻滞组患者股四头肌肌力和关节活动度恢复较股神经阻滞快,有利于患者早期进行功能锻炼和及早恢复。

Objective To study the effects of the femoral nerve block and adductor canal block on postoperative an-algesia and movement in patients with total knee arthroplasty（TKA）. Methods A total of 50 TKA patients were randomly di-vided into an experimental group and a control group. The patients in the experimental group received adductor canal blockanalgesia, while the patients in the control group accepted femoral nerve block analgesia. After the operation, all the patientswere given an analgesia pump. The preoperative and postoperative（2 h, 6 h, 12 h, 24 h, 48 h respectively） visual analoguescale（VAS） scores, and preoperative and postoperative quadriceps muscle and joint mobility were observed and compared be-tween the two groups. Results The VAS scores of preoperative rest pain and activity pain had no significant difference be-tween the two groups（P 〉 0.05）, and the VAS scores of rest pain and activity pain in postoperative 2 h, 6 h, 12 h, 24 h, 48 hhad also no significant differences between the two groups（all P 〉0.05）. The patients in the adductor block group（the experi-mental group） in postoperative 24 h and 48 h had obviously better quadriceps muscle strength than the patients in the femoralnerve block group（the control group） had（P 〈0.05）, but there was no significant difference between the two groups in thequadriceps muscle strength in postoperative 72 h（P 〉 0.05）. The patients in the adductor canal block group had significantlybetter knee joint activities than the patients in the femoral nerve block group had in all time points（P〈 0.05）. Conclusion The femoral nerve block and adductor block in TKA patients have the similar postoperative analgesia effect, but the patientsin the adductor block group restore quadriceps muscle and joint mobility faster than the patients in the femoral nerve blockgroup do, and therefore, the adductor block is benefit of TKA patients＇ early functional exercises and fast recovery.