保留膈肌技术在肩关节镜手术中的研究进展

Research Progress of Diaphragm Sparing Technique in Arthroscopic Shoulder Surgery

肩关节镜手术因其切口小、组织损伤少、技术成熟从而被广泛应用,但其术后中重度的疼痛强度不亚于膝关节置换和开胸手术。肌间沟臂丛神经阻滞是目前肩关节镜手术术后镇痛的金标准,当注射的局部麻醉药物容量≥20 mL时患侧膈肌麻痹发生率为100%,同时此路径神经阻滞相关并发症发生率也较高,从而限制其在肺功能不全、肥胖、阻塞性睡眠呼吸暂停综合征患者中的使用。近年来,世界各地的学者都致力于探索在不降低镇痛效果的前提下,最大限度减少膈肌麻痹发生率的新方案,本文将对近年来提出的肩关节镜手术中保留膈肌技术作一综述。

Arthroscopic shoulder surgery is widely used because of its small incision,less tissue damage and mature technology,but its postoperative moderate and severe pain intensity is no less than that of knee arthroplasty and thoracotomy.Interscalene brachial plexus block is the gold standard for postoperative analgesia in arthroscopic shoulder surgery.When the injected local anesthetic volume is≥20 mL,the incidence of diaphragmatic paralysis on the affected side is 100%.At the same time,the incidence of complications related to this path nerve block is also high,which limits its use in patients with pulmonary insufficiency,obesity and obstructive sleep apnea syndrome.In recent years,scholars all over the world are committed to exploring a new scheme to minimize the incidence of diaphragmatic paralysis without reducing the analgesic effect.This paper will review the diaphragmatic preservation technology in arthroscopic shoulder surgery proposed in recent years.