股神经阻滞与收肌管阻滞应用于胫骨结节截骨联合内侧髌股韧带重建术后镇痛疗效及早期功能比较研究

Comparative Study on Analgesic Efficacy and Early Knee Function of Femoral Nerve Block and Adductor Canal Block after Tibial Tuberosity Osteotomy Combined with Medial Patellofemoral Ligament Reconstruction

目的:比较收肌管阻滞(adductor canal block,ACB)与股神经阻滞(femoral nerve block,FNB)用于胫骨结节截骨联合内侧髌股韧带重建术后的镇痛效果及早期功能。方法:前瞻性选取2019年2月至2021年9月在本院进行胫骨结节截骨联合内侧髌股韧带重建术的42例复发性髌骨脱位患者,采用随机数字表法分为ACB组(21例)和FNB组(21例)。ACB组患者行收肌管阻滞,FNB组患者行股神经阻滞,评价两组术后在镇痛效果、关节活动度、股四头肌肌力和功能恢复等指标方面的差异。结果:术后48 h静息状态和运动状态下的疼痛视觉模拟评分法(VAS)评分,ACB组(5.5±1.6和6.1±1.6)优于FNB组(6.3±1.8和6.9±1.8),差异具有统计学意义(P<0.05),术后12 h和24 h差异无统计学意义。术后12 h和24 h的股四头肌肌力方面,ACB组优于FNB组,差异有统计学意义(P<0.05),术后48 h未见显著性差异。ACB组最大屈膝角度达到90°所需时间为2.8±0.5天,FNB组为4.2±0.6天,两组差异具有统计学意义(P=0.018)。结论:对于行胫骨结节截骨联合内侧髌股韧带重建术的复发性髌骨脱位患者,收肌管阻滞在保留股四头肌肌力及早期恢复膝关节活动度方面优于股神经阻滞。

Objective To compare the analgesic effect and early function of adductor canal block(ACB)and femoral nerve block(FNB)after tibial tuberosity osteotomy and medial patellofemoral ligament reconstruction.Methods Forty-two recurrent patellar dislocation patients to undergo tibial tuberosity osteotomy and medial patellofemoral ligament reconstruction in Beijing Jishuitan Hospital between February 2019 and September 2021 were selected and randomly divided into an ACB group and an FNB group,each of 21,according to a random number table.The ACB group underwent adductor canal block,while the FNB group received femoral nerve block.Then the postoperative analgesic effect,joint range of motion,quadriceps muscle strength and functional recovery were evaluated and compared between the two groups.Results The average visual analogue scale scores of the ACB group at rest and exercise were 5.5±1.6 and 6.1±1.6,significantly better than the corresponding values of the FNB group(6.3±1.8 and 6.9±1.8)48 hours after surgery(P<0.05).However,no significant differences were found between the two groups in this value 12 and 24 hours after surgery.Moreover,12 and 24 hours after surgery,the quadriceps muscle strength of the ACB group was significantly better than the FNB group(P<0.05),while there were no significant differences between the two groups48 hours after the surgery.The time required for the maximum knee flexion angle to reach 90°was2.8±0.5 days in the ACB group,significantly shorter than 4.2±0.6 days of the FNB group(P=0.018).Conclusion For recurrent patellar dislocation patients undergoing tibial tuberosity osteotomy combined with medial patellofemoral ligament reconstruction,adductor canal block may be superior to femoral nerve block in terms of preserving quadriceps muscle strength and early restoration of knee joint range of motion.