分析多模式镇痛下持续髂筋膜间隙阻滞与收肌管阻滞对老年患者全膝关节置换术后快速康复的影响

Effect of Continuous Iliofascial Space Block and Adductor Canal Block un⁃der Multi-modal Analgesia on Rapid Recovery after Total Knee Replace⁃ment in Elderly Patients

目的探讨对老年人全膝关节置换术患者在多模式镇痛下分别给予超声引导下持续髂筋膜间隙阻滞以及收肌管阻滞对术后快速康复的影响。方法随机选取2020年2月—2022年11月常州市中医医院收治的60例老年人全膝关节置换术患者为研究对象,以随机数表法分为研究组和参照组,每组30例。参照组在多模式镇痛基础下施以超声引导下持续髂筋膜间隙阻滞,研究组在多模式镇痛基础下施以超声引导下持续收肌管阻滞。对比两组患者动态视觉模拟评分法(Visual Analogue Scale,VAS)评分、术后各时间点静息状态VAS评分、美国特种外科医院膝关节评分量表(Hospital for Special Surgery Knee Score,HSS)评分以及膝关节关节活动度(Range of Motion,ROM)。结果术后6、12、24、48 h,两组VAS评分比较,差异无统计学意义(P均>0.05)。研究组HSS评分为(71.25±7.25)分,高于参照组的(63.55±6.79)分,差异有统计学意义(t=4.246,P<0.05)。术后3、7、10、12 d,研究组ROM均高于参照组,差异有统计学意义(P均<0.05)。结论临床对老年人全膝关节置换术患者在给予镇痛干预期间,同超声引导下持续髂筋膜间隙阻滞比较,超声引导下持续收肌管阻滞方法的有效应用,可对患者的术后早期康复给予明显促进。

Objective To investigate the effect of continuous iliofascial space block and adductor canal block under multi-mode analgesia on rapid postoperative recovery in elderly patients with total knee replacement.Methods Sixty elderly patients with total knee arthroplasty treated in Changzhou Hospital of Traditional Chinese Medicine from Feb-ruary 2020 to November 2022 were randomly selected as the study objects,and were divided into study group and ref-erence group by random number table method,with 30 cases in each group.The reference group received continuous iliofascial space block under the guidance of ultrasound under the basis of multi-mode analgesia,and the study group received continuous adductor block under the guidance of ultrasound under the basis of multi-mode analgesia.Com-pared the dynamic Visual Analog Scale(VAS)score,postoperative resting state VAS score,Hospital for Special Sur-gery Knee Score(HSS)score,and Range of Motion(ROM)between two groups of patients.Results There was no statis-tically significant difference in VAS scores between the two groups at 6 h,12 h,24 h and 48 h after surgery(all P>0.05).The HSS score of the study group was(71.25±7.25)points,higher than that of the reference group(63.55±6.79)points,and the difference was statistically significant(t=4.246,P<0.05).At 3 d,7 d,10 d and 12 d after operation,the ROM of the study group was higher than those of the reference group,and the differences were statistically significant(all P<0.05).Conclusion Compared with continuous iliofascial space block under ultrasound guidance,the effective ap-plication of continuous adductor block under ultrasound guidance can significantly promote the early postoperative re-habilitation of elderly patients undergoing total knee replacement during analgesic intervention.