超声引导下连续收肌管阻滞联合关节周围浸润对全膝关节置换术后的镇痛效果

The Analgesic Effect of Continuous Adductor Tube Block Combined with Per-articular Infiltration Under Ultrasound Guidance After Total Knee Arthroplasty

目的评价超声引导下连续收肌管阻滞(CACB)联合关节周围浸润镇痛(PLIA)对全膝关节置换术后镇痛和早期康复的影响。方法选择2019年7月~2020年10月于天津市第一中心医院择期行单侧全膝关节置换术(TKA)治疗的患者44例,根据镇痛模式不同分为观察组和对照组,每组22例。对照组给予单纯PLIA镇痛,观察组采用CACB联合PLIA镇痛,比较两组术后最早下地活动时间、住院时间、住院满意度和术后3、6、12、24、48 h静息和动态VAS评分、股四头肌肌力以及术后12、24、48 h膝关节活动度。结果两组术后3、6 h静息和动态VAS评分比较,差异无统计学意义(P>0.05);但术后12、24、48 h观察组静息和动态VAS评分均优于对照组,差异有统计学意义(P<0.05);两组患者术后各时间点股四头肌肌力比较,差异无统计学意义(P>0.05),且肌力均大于Ⅲ级,早期功能锻炼不受影响;术后12、24、48 h,观察组主动屈膝角度大于对照组,差异有统计学意义(P<0.05);观察组术后下床活动时间早于对照组,差异有统计学意义(P<0.05);两组住院时间和住院满意度比较,差异无统计学意义(P>0.05)。结论超声引导下连续收肌管阻滞联合关节周围浸润镇痛不影响患者术后股四头肌肌力的恢复,且镇痛效果优于单纯PLIA模式,更有利于患者早期膝关节功能康复锻炼,值得临床应用。

Objective To evaluate the effect of ultrasound-guided continuous adductor tube block(CACB)combined with periarticular infiltration analgesia(PLIA)on analgesia and early rehabilitation after total knee arthroplasty.Methods A total of 44 patients who underwent unilateral total knee arthroplasty(TKA)treatment at Tianjin First Central Hospital from July 2019 to October 2020 were selected.According to different analgesia patterns,they were divided into observation group and control group,with 22 cases in each group.The control group was given simple PLIA analgesia,and the observation group was given CACB combined with PLIA analgesia.The two groups were compared with the earliest postoperative time of activity,hospitalization time,hospitalization satisfaction,and 3,6,12,24,and 48 h rest and dynamics after surgery.VAS score,quadriceps muscle strength,and knee range of motion at 12,24,and 48 h after surgery.Results There was no statistically significant difference in the resting and dynamic VAS scores between the two groups at 3 and 6 h after surgery(P>0.05);However,the resting and dynamic VAS scores of the observation group were better than those of the control group at 12,24,and 48 h after operation,the difference was statistically significant(P<0.05);There was no significant difference in quadriceps muscle strength between the two groups of patients at various time points after surgery(P>0.05).The muscle strength was greater than gradeⅢ,early functional exercise was not affected;12,24,and 48 h after surgery,the active knee flexion angle of the observation group was greater than that of the control group,the difference was statistically significant(P<0.05);The time of getting out of bed after operation in the observation group was earlier than that in the control group,the difference was statistically significant(P<0.05);There was no significant difference in hospitalization time and hospitalization satisfaction between the two groups(P>0.05).Conclusion Ultrasound-guided continuous adductor tube block combined with peri-articular infiltration analgesia does not affect the recovery of quadriceps muscle strength after surgery,and the analgesic effect is better than the PLIA mode alone,which is more conducive to the early rehabilitation of the knee joint function.It is worthy of clinical application.