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| 徒手法收肌管阻滞用于人工全膝关节置换术的效果 |
| Effect of manual method adductor canal block for total knee arthroplasty |
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| DOI：10.12089/jca.2019.03.014 |
| 中文关键词: 徒手法 超声引导 收肌管阻滞 人工全膝关节置换术 |
| 英文关键词: Manual method Guided by ultrasound method Total knee arthroplasty Adductor canal block |
| 基金项目: |
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| 中文摘要: |
目的 比较徒手法收肌管阻滞（ACB）与超声引导法ACB对人工全膝关节置换术（TKA）患者术后镇痛及术后患肢运动功能恢复情况的影响。
方法 选择2017年10月至12月择期行初次单侧TKA的患者77例，男28例，女49例，年龄50~80岁，BMI 20～40 kg/m2，ASA Ⅰ—Ⅲ级。随机分为徒手法组（T组，n=38）和超声引导法组（B组，n=42）。T组采用徒手法ACB；B组采用超声引导法ACB。记录两组患者术前1 d和术后24 h股四头肌肌力分级和膝关节活动度（ROM）。记录两组患者术前1 d、术后2、8、12、24 h静息和活动时视觉模拟评分(VAS评分)。记录两组患者阻滞后15 min、术后2 h内踝感觉消失率，患者满意度评分。采用多元线性回归分析T组患者穿刺深度与年龄、身高、体重、BMI和穿刺点腿围的相关性并进一步进行相关性分析。记录是否发生口唇麻木、味觉异常、头晕、耳鸣等局麻药中毒事件，术后24 h内阿片类药物使用情况，恶心、呕吐、谵妄、尿潴留等不良反应情况，穿刺部位是否有出血/淤伤、感染和跌倒/坠床等并发症发生情况。
结果 两组患者不同时点股四头肌肌力分级和膝ROM差异无统计学意义，术前1 d、术后2、8、12、24 h静息和活动时VAS评分差异无统计学意义。阻滞15 min T组内踝感觉消失率明显低于B组（P<0.05），术后2 h 两组均完全被阻滞。两组患者满意度评分差异无统计学意义。T组患者穿刺点腿围与穿刺深度存在明显的线性相关（r=0.764，P<0.01）。两组患者术后24 h内均未使用阿片类镇痛药，两组患者恶心、呕吐发生情况差异无统计学意义。
结论 全膝关节置换术后镇痛采用高容量徒法收肌管阻滞与超声法比较，均镇痛效果明显而且不影响术后患肢运动功能，有助于患者的术后快速康复。 |
| 英文摘要: |
Objective To investigate the effects of manual method adductor canal block(ACB) and ultrasound-guided method ACB on postoperative analgesia and postoperative limb motor function recovery in patients who underwent total knee arthroplasty (TKA).
Methods Seventy-seven patients , 28 males and 49 females, aged 50 - 80 years, BMI 20 - 40 kg/m2，ASA physical status Ⅰ-Ⅲ, were recruited and scheduled to undergo primary unilateral TKA from October to December 2017. They were randomly divided into two groups: manual method group（group T, n = 38）and ultrasound-guided method（group B, n =40）. ACB was manipulated by manual method in group T, and was manipulated by ultrasound-guided method in group B. Quadriceps strength grading and joint activity（ROM）were recorded 1 day before and after operation in both groups. Visual analogue score (VAS) was recorded during rest and activity 1 day before, and 2, 8, 12, 24 h after operation in both groups. The disappearance rate of medial malleolus sensation and patient satisfaction score were recorded 15 min after blockade and 2 h after operation. Multivariate linear regression analysis was used to analyze the correlation between puncture depth and age, height, weight, BMI and puncture point leg circumference in group T. The occurrence of local anesthetic toxicity events such as lip numbness, taste abnormality, dizziness, tinnitus, and opioid use, nausea and vomiting, delirium, urinary retention and other adverse effects within 24 h after operation were recorded. The occurrence of complications such as bleeding/bruising, infection at the puncture site and fall/falling out of bed were recorded.
Results There was no significant difference in quadriceps strength grade and ROM at different time points between the two groups. There was no significant difference in VAS score during rest and activity 1 day before operation, and 2, 8, 12, 24 h after operation between the two groups. The disappearance rate of medial malleolus sensation in group T was significantly lower than that in group B (P < 0.05), and was completely blocked 2 h after operation in the two groups. There was no significant difference in satisfaction score between the two groups. There was a significant linear correlation between puncture point leg circumference and puncture depth in group T (r = 0.764, P < 0.01). Opioid analgesics were not used in both groups within 24 h after operation. There was no significant difference in the occurrence of nausea and vomiting between the two groups.
Conclusion Compare with the method of ultrasound-guided, High capacity of manual method ACB can be used for postoperative analgesia in patients underwent TKA. It has remarkable analgesic effect and does not affect postoperative limb motor function, also helps patients with rapid postoperative rehabilitation. |
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