超声引导下腘窝上和大转子下外侧入路坐骨神经阻滞应用于老年全膝关节置换术后镇痛的效果比较

Comparison of the analgesic effect between ultrasound-guided popliteal fossa superior and lower lateral approaches of the greater trochanter for sciatic nerve block in the elderly after total knee arthroplasty

目的:探讨超声引导下入路坐骨神经阻滞在全膝关节置换术中的应用效果。方法:选取行单侧全膝关节置换术病人120例,按照随机数表法分为A、B组,各60例,A组行大转子下外侧入路坐骨神经阻滞,B组行腘窝上外侧入路坐骨神经阻滞。比较2组坐骨神经阻滞指标,感觉及运动阻滞起效时间、维持时间及阻滞效果等。结果:B组操作完成时间明显短于A组(P<0.01),穿刺次数明显少于A组(P<0.01),穿刺深度明显小于A组(P<0.01),穿刺成功率、阻滞成功率和病人满意度均明显高于A组(P<0.01)。2组阻滞起效时间和持续时间差异均无统计学意义(P>0.05),B组病人感觉和运动阻滞效果评分均明显高于A组(P<0.01)。2组术后8 h疼痛VAS评分差异无统计学意义(P>0.05)。B组病人术后8 h股后肌群肌力均达到Ⅲ级及以上,明显优于A组(P<0.01)。结论:超声引导腘窝上外侧入路坐骨神经阻滞在全膝关节置换术后中操作穿刺时间较短,进针深度更浅,穿刺及阻滞成功率较高,病人满意度高,股后肌群肌力较好,值得临床推广。

Objective:To investigate the effects of ultrasound-guided sciatic nerve block in total knee replacement.Methods:One hundred and twenty patients with unilateral total knee arthroplasty were divided into the group A and group B according to the random number table method(60 cases each group).The group A were treated with sciatic nerve block through the greater trochanteric lateral approach,and the group B were treated with sciatic nerve block through upper lateral popliteal approach.The sciatic nerve block index,sensory and r motor block onset time,maintenance time and block effects were compared between two groups.Results:The operation time,number of punctures and puncture depth in group B were significantly less than those in group A(P<0.01).The puncture success rate,block success rate and patient satisfaction in group B were significantly higher than those in group A(P<0.01).There was no statistical significance in the onset and duration of block between two groups(P>0.05),and the block effect scores of sensory and motor in group B were significantly higher than those in group A(P<0.01).There was no statistical significance in the VAS scores after 8 h of surgery between two groups(P>0.05).The muscle strength of the posterior femoris in the group B after 8h of operation achievedⅢlevel and above,and which was significantly better than that in group A(P<0.01).Conclusions:The ultrasound-guided upper lateral popliteal approach to sciatic nerve block after total knee arthroplasty is short puncture time,shallow penetration depth,high success rates of puncture and block,and good patient satisfaction and muscle strength of the posterior femoral muscle,which is worthy of clinical promotion.