单次股神经阻滞联合关节腔周围注射在膝关节置换术后镇痛的研究

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摘要目的观察单次股神经阻滞联合关节腔周围注射在全膝关节置换术后的镇痛效果。方法选取2017年1月至2018年5月于我院拟行全膝关节置换术的患者共50例，其中男22例，女28例；年龄60~80岁，平均为(69.90±9.46)岁。50例患者随机分为实验组(单次股神经阻滞联合关节腔周围注射组)和对照组(单次股神经阻滞组)，每组各25例。比较两组患者术后静息和运动状态视觉模拟评分(visual analogue scale，VAS)、术后膝关节活动度(range of motion，ROM)及不良反应发生情况。结果实验组在术后6 h、12 h、24 h、48 h静息及运动状态VAS评分均比对照组同期VAS评分低，差异有统计学意义(P＜0.05)；实验组术后1 d、2 d膝关节活动度比对照组同期膝关节活动度高(P＜0.05)，但术后3 d、7 d两组患者术后膝关节活动度比较差异无统计学意义(P＞0.05)。两组患者术后并发症发生率比较差异无统计学意义(P＞0.05)。结论对于膝关节置换患者，单次股神经阻滞联合关节腔周围注射比单纯单次股神经阻滞更能缓解患者术后早期的疼痛，有助于患者术后早期行功能锻炼，且不增加术后并发症发生，但对于患者远期功能恢复并无明显优势。

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关键词 ：全膝关节置换术, 术后镇痛, 关节腔周围注射, 单次股神经阻滞

Abstract：Objective To evaluate the analgesic effect of single-shot femoral nerve block combined with periarticular injection after total knee arthroplasty.Methods 50 patients with total knee arthroplasty were selected from January 2017 to May 2018 in our hospital.There were 22 males and 28 females.The patients were 60 to 80 years old and the average age was(69.90±9.46).All of them were divided into the experimental group of combined periarticular injection of analgesia and single-shot femoral nerve block，or the control group of single-shot femoral nerve block alone group randomly.There were 25 cases in each group.The VAS score at rest and in activity，ROM，the rate of adverse reactions after operation was compared between the two groups.Results The experimental group had significantly lower VAS score than the control group at 6，12，24，48h both at rest and in activity (P＜0.05).The ROM in the experimental group were also significantly better than the control group at 1 and 2 days after the operation，while there was on difference in the ROM at 3 and 7 days after the operation between the two groups (P＞0.05)，and there was no significant difference in postoperative complications between the two groups(P＞0.05).Conclusion Combination of periarticular injection of analgesia and single-shot femoral nerve block is more effective than femoral nerve block alone in relieving early postoperative pain，which indeed helpful to early functional exercise.And there was no increase in postoperative complications.However，no significant advantage for long-term functional recovery has been found.

通讯作者: 李云

作者简介: 巩建宝(1987－ )，男，主治医师，青岛大学附属青岛市市立医院骨关节与运动医学科，266071。

引用本文:

巩建宝，丁源，高超华，乔原，李云 *. 单次股神经阻滞联合关节腔周围注射在膝关节置换术后镇痛的研究[J]. 实用骨科杂志, 2020, 26(4): 301-326.
Gong Jianbao，Ding Yuan，Gao Chaohua，et al. Study on Analgesic Effect of Single-Shot Femoral Nerve Block Combined with Periarticular Injection After Total Knee Arthroplasty. sygkzz, 2020, 26(4): 301-326.

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http://www.sygkzz.com/CN/ 或 http://www.sygkzz.com/CN/Y2020/V26/I4/301

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