中国修复重建外科杂志

中国修复重建外科杂志

收肌管阻滞麻醉联合局部浸润麻醉镇痛对初次人工全膝关节置换术后康复的影响

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目的 探讨收肌管阻滞麻醉联合局部浸润麻醉镇痛对初次人工全膝关节置换术(total knee arthroplasty,TKA)后康复的影响。 方法 将 2017 年 3 月—8 月拟行初次单侧 TKA 且符合选择标准的 104 例患者纳入研究,随机分为试验组(53 例)和对照组(51 例)。试验组行收肌管阻滞麻醉联合术中局部浸润麻醉镇痛,对照组仅行术中局部浸润麻醉镇痛。两组患者性别、年龄、体质量指数、病因、侧别、病程、术前美国麻醉医师学会(ASA)分级等一般资料比较,差异均无统计学意义(P>0.05),具有可比性。比较两组手术时间、住院时间、并发症发生情况,以及术后静息状态及活动时膝关节切口疼痛视觉模拟评分(VAS)、膝关节屈伸活动度、肢体肿胀情况(大腿周径)、步行距离以及步行时切口疼痛 VAS 评分。 结果 试验组手术时间较对照组明显缩短(t=–2.861,P=0.005);但两组住院时间比较差异无统计学意义(t=–0.975,P=0.332)。术后试验组 1 例、对照组 2 例出现切口渗液,试验组 2 例、对照组 3 例出现血肿,两组各 1 例出现无症状性肌间静脉血栓,试验组 14 例、对照组 15 例出现瘀斑;两组以上并发症发生率比较差异均无统计学意义(P>0.05)。两组术前静息状态及活动时膝关节 VAS 评分、膝关节屈伸活动度、大腿周径比较,差异均无统计学意义(P<0.05)。但试验组术后 2、4、8、12 h 时静息状态及活动时 VAS 评分,术后 1、2 d 膝关节屈伸活动度,术后出院时步行距离,术后 1、2 d 及出院时步行疼痛 VAS 评分、术后 1 d 大腿周径均优于对照组,差异有统计学意义(P<0.05)。 结论 对于初次 TKA 患者,采用收肌管阻滞麻醉联合局部浸润麻醉镇痛能够减轻切口早期疼痛,有利于术后早期膝关节活动度和功能的康复。

Objective To investigate the effect of adductor canal block combined with local infiltration anesthesia on the rehabilitation of primary total knee arthroplasty (TKA). Methods A total of 104 patients who met the selection criteria for the first unilateral TKA between March 2017 and August 2017 were included in the study. They were randomly divided into trial group (53 cases) and control group (51 cases). In the trial group, the adductor canal block with intraoperative local infiltration anesthesia were performed. In the control group, only intraoperative local infil-tration anesthesia was performed. There was no significant difference in gender, age, body mass index, diagnosis, effected side, and the preoperative American Society of Anesthesiologists (ASA) grading between 2 groups (P>0.05). The operation time, length of stay, and complications were compared between 2 groups, as well as visual analogue scale (VAS) score of incision at rest and during activity, the range of motion (ROM) of knee flexion and extension activity, limb swelling (thigh circumference), walking distance, and pain VAS score while walking. Results The operation time of the trial group was significantly shorter than that of the control group (t=–2.861, P=0.005). However, there was no significant difference in length of stay between 2 groups (t=–0.975, P=0.332). The wound effusion occurred in 1 patient of trial group and 2 of control group; hematoma occurred in 2 patients of trial group and 3 of control group; no symptom of intermuscular venous thrombosis occurred in 1 patient in each of 2 groups; ecchymosis occurred in 14 patients of trial group and 15 of control group; there was no significant difference in the incidence of related complications between 2 groups (P>0.05). There was no significant difference in the preoperative VAS score at rest and during activity, ROM of knee flexion and extension activity, and thigh circumference between 2 groups (P>0.05). However, there were significant differences in the VAS score at rest and during activity after 2, 4, 8, and 12 hours, ROM of knee flexion and extension activity after 1 and 2 days, and the walking distance on the day of discharge, pain VAS scores while walking after 1 and 2 days and on the day of discharge, and thigh circumference after 1 day between 2 groups (P<0.05). Conclusion For the primary TKA, the adductor canal block combined with local infiltration anesthesia can early relieve the initial pain of the incision, shorten the operation time, and promote the mobility and functional recovery of the knee joint.

关键词: 收肌管阻滞麻醉; 局部浸润麻醉; 人工全膝关节置换术; 术后康复

Key words: Adductor canal block; local infiltration anesthesia; total knee arthroplasty; postoperative rehabilitation

引用本文: 侯晓玲, 罗泽宇, 王浩洋, 詹瑜佳, 杨璐, 李玲利. 收肌管阻滞麻醉联合局部浸润麻醉镇痛对初次人工全膝关节置换术后康复的影响. 中国修复重建外科杂志, 2018, 32(8): 1006-1011. doi: 10.7507/1002-1892.201801082 复制

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