超声引导联合神经刺激隐神经阻滞干预全膝关节置换术后患者的效果

目的观察超声引导联合神经刺激隐神经阻滞(SNB)对全膝关节置换术(TKA)后患者的干预效果。方法将50例接受单侧TKA的老年膝关节骨性关节炎(OA)患者随机分为A、B组(各25例)。对A组于TKA麻醉前行超声联合神经刺激仪引导股神经阻滞(FNB),B组采用超声联合神经刺激仪引导SNB。对比2组术前及术后24 h、48 h、72 h、1周和2周时视觉模拟评分(VAS)、膝关节最大屈曲度和股四头肌肌力,术后运动恢复及感觉恢复时间,并统计不良反应。结果2组术后各时间点VAS差异均无统计学意义(P均>0.05)。A组术后48 h、72 h、1周、2周膝关节最大屈曲度均小于B组(P均<0.05),股四头肌肌力术后24 h、48 h及72 h均低于B组(P均<0.05)。A组运动恢复时间为术后(25.28±4.55)h,感觉恢复时间为术后(33.20±2.92)h,均长于B组(14.64±2.16)h、(28.84±3.27)h,P均<0.001]。术后2周内,A组2例出现呕吐,B组1例头晕、1例呕吐;未见低血压等不良反应。结论超声引导联合神经刺激SNB干预对TKA后OA患者安全有效,且促进感觉及运动功能恢复效果优于FNB。

Effect of ultrasound combined with nerve stimulator in guiding saphenous nerve block on patients after total knee arthroplasty

Objective To observe the effect of ultrasound combined with neurostimulator in guiding saphenous nerve block (SNB) on elderly knee osteoarthritis (OA) patients after total knee arthroplasty (TKA). Methods A total of 50 elderly OA patients who would undergo unilateral TKA were randomly divided into group A and group B (each n=25). Patients in Group A underwent ultrasound and nerve stimulator guided femoral nerve block (FNB), while in group B underwent ultrasound and nerve stimulator guided SNB. Visual analogue score (VAS), maximum knee flexion and quadriceps strength, the time of postoperative motor recovery and sensory recovery, as well as the complications before operation and 24 h, 48 h, 72 h, 1 week and 2 weeks after operation were recorded and compared. Results There was no significant difference of VAS between groups at any time point (all P>0.05). The maximum knee flexion 48 h, 72 h, 1 week and 2 weeks after surgery in group A were all less than in group B (all P<0.05). Quadriceps muscle strength 24 h, 48 h and 72 h of post operation in group A were lower than in group B (all P<0.05). In group A, motor recovery time was (25.28±4.55)h, and sensory recovery time was (33.20±2.92)h, which in group B was (14.64±2.16)h and (28.84±3.27)h, respectively (both P<0.001). Within 2 weeks after operation, vomiting was observed in 2 cases of group A and 1 case of group B, while dizziness was noticed 1 case of group B. No adverse reaction such as hypotension occurred. Conclusion Ultrasound combined with neurostimulator-guided SNB is safe and effective for managing OA patients after TKA, which is superior to FNB in promoting sensory and motor function recovery.