人工全膝关节置换术中关节周围局部浸润麻醉注射部位研究进展

Progress of injection sites of local infiltration analge esia in total knee

目的综述人工全膝关节置换术(total knee arthroplasty,TKA)术中关节周围局部浸润麻醉(local infiltration analgesia,LIA)注射部位的研究进展。方法广泛查阅国内外相关文献,阐述膝关节疼痛发生相关机制和神经解剖学,并总结临床研究中LIA注射部位的选择和不同注射部位的临床效果差异。结果膝关节各组织中存在大量伤害感受器,其中髌腱、髌下脂肪垫、外侧副韧带附着处、髂胫束附着处、髌上囊、后方关节囊等部位对疼痛更加敏感。目前大多数研究支持对侧方关节囊、侧副韧带、支持带、股四头肌肌腱、脂肪垫和皮下组织进行注射,是否对膝关节后部及骨膜下进行注射则存在争议。结论膝关节各组织对疼痛敏感性的差别,对TKA术中LIA注射部位的选择具有指导意义。有关TKA术中LIA注射部位的选择虽已有临床研究,但存在一定局限性,仍未确定最优方案,有待进一步研究明确。

Objective To review the research progress of injection sites of local infiltration analgesia(LIA)in total knee arthroplasty(TKA).Methods The relevant domestic and foreign literature in recent years was extensively reviewed.The neuroanatomy of the knee,and the research progress of the selection and the difference of effectiveness between different injection sites of LIA in clinical studies were summarized.Results Large concentrations of nociceptors are present throughout the various tissues of the knee joint.Patellar tendon,subpatellar fat pad,lateral collateral ligament insertions,iliotibial band insertions,suprapatellar capsule,and posterior capsule were more sensitive to pain.Most current studies support injections into the lateral capsule,collateral ligament,retinaculum,quadriceps tendon,fat pad,and subcutaneous tissue.Whether to inject into the back of the knee and subperiosteum is controversial.Conclusion The relative difference of knee tissue sensitivity to pain has guiding significance for the selection of LIA injection site after TKA.Although researchers have conducted clinical trials on injection site and technique of LIA in TKA,there are certain limitations.The optimal scheme has not been determined yet,and further studies are needed.