超声引导下膝关节囊后间隙联合收肌管阻滞对全膝关节置换术患者的镇痛效果分析

目的观察超声引导下膝关节囊后间隙联合收肌管阻滞对全膝关节置换术患者的镇痛效果。方法纳入自2018-02—2018-08完成的单侧全膝关节置换术,A组39例采用超声引导下膝关节囊后间隙联合收肌管阻滞镇痛,B组43采用超声引导下坐骨神经联合收肌管阻滞镇痛。结果A组术后镇痛药物使用量为(638.9±125.6)mg,B组为(601.3±132.9)mg,差异无统计学意义(P>0.05)。A组与B组术后12、24、48、72 h静息及运动状态下疼痛VAS评分差异无统计学意义(P>0.05)。A组术后12、24、48 h膝关节活动度优于B组,差异有统计学意义(P<0.05);A组与B组术后72 h膝关节活动度差异无统计学意义(P>0.05)。A组与B组术后12、24、48、72 h大腿肌群肌力差异无统计学意义(P>0.05)。A组术后12、24 h小腿肌群肌力优于B组,差异有统计学意义(P<0.05)。A组与B组术后72 h小腿肌群肌力均恢复为5级。结论全膝关节置换术中采用超声引导下膝关节囊后间隙联合收肌管阻滞镇痛可取得满意效果,不影响下肢后群肌肉力量及功能锻炼,对于患者术后实现快速康复具有较高的临床应用价值。

Analgesic effect of ultrasound-guided posterior capsular space of knee joint combined with adductor cannal block in patients undergoing total knee arthroplasty

Objective To observe the analgesic effect of ultrasonic guided posterior space of knee joint combined with adductor canal block in patients undergoing total knee arthroplasty.Methods The patients with unilateral total knee arthroplasty completed from February 2018 to August 2018 was included.Thirty-nine patients in group A were treated with ultrasoundguided posterior space of knee joint capsule combined with adductor canal block analgesia while 43 patients in group B were treated with ultrasound-guided sciatic nerve combined with adductor canal block analgesia.Results The dosage of postoperative analgesic drugs in group A was(638.9±125.6)mg,and that in group B was(601.3±132.9)mg,and the difference was not statistically significant(P>0.05).There was no significant difference in VAS score between group A and group B at 12,24,48 and 72 h after operation when resting and exercising(P>0.05).The range of motion of knee joint in group A was better than that in group B at 12,24 and 48 h postoperatively,and the difference was statistically significant(P<0.05).There was no significant difference in the range of motion of knee joint between group A and group B at 72 h after surgery(P>0.05).There was no significant difference in thigh muscle strength between group A and group B at 12,24,48 and 72 h after surgery(P>0.05).The muscle strength of calf muscle group of group A was better than that of group B at 12 and 24 h after surgery,and the difference was statistically significant(P<0.05).The calf muscle strength of group A and group B recovered to level 5 at 72 h after surgery.Conclusion In total knee arthroplasty,ultrasound-guided posterior space of the knee joint combined with adductor canal block analgesia can achieve satisfactory results without affecting the muscle strength and functional exercise of the lower extremity.It is of high clinical application value for patients to achieve rapid postoperative rehabilitation.