| 张瀚鹏,赵 巍,钮峥嵘,哈巴西·卡肯,王 利.股神经阻滞和收肌管阻滞对全膝关节置换术后下肢静脉血栓形成的影响[J].,2020,(13):2516-2519 |
| 股神经阻滞和收肌管阻滞对全膝关节置换术后下肢静脉血栓形成的影响 |
| Effect of Femoral Nerve Block and Adductor Canal Block on Deep Venous Thrombosis after Total Knee Arthroplasty |
| 投稿时间：2020-02-25 修订日期：2020-03-21 |
| DOI：10.13241/j.cnki.pmb.2020.13.024 |
| 中文关键词: 全膝关节置换术 收肌管阻滞 股神经阻滞 术后镇痛 下肢静脉血栓 |
| 英文关键词: Total knee arthroplasty Adductor canal block Femoral nerve block Postoperative analgesia Deep venous thrombosis |
| 基金项目:国家自然科学基金项目（3156060044） |
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| 中文摘要: |
| 摘要 目的：探究股神经阻滞（femoral nerve block，FNB）和收肌管阻滞（adductor canal block，ACB）对全膝关节置换术（total knee arthroplasty，TKA）后下肢静脉血栓形成的影响。方法：将2019年3月-2019年4月拟在全身麻醉下行全膝关节置换术的40例患者随机分为FNB组和ACB组，所有患者均给予超声引导下单次注射，术后均给予标准化抗凝治疗。术后评估两组患者不同时间节点的疼痛评分、股四头肌肌力及术后下肢静脉血栓形成情况。结果：两组患者术后2、6、12、24、48、72 h患肢术区局部疼痛的VAS评分差异无统计学意义（P>0.05）。ACB组患者术后2、6、12、24、48 h股四头肌肌力均明显高于FNB组（P<0.05），术后72 h两组患者股四头肌肌力无明显差异（P>0.05）。ACB组在术后患者首次直腿抬高时间（4.5±4.6）h，显著低于FNB组在术后患者首次直腿抬高时间（25.6±12.6）h，两组对比差异有统计学意义（P<0.05）。术后72 h给予两组患者复查双下肢血管超声，复查结果显示，FNB组19例患者中共有2例出现下肢静脉血栓，均为肌间隙静脉血栓形成；ACB组20例患者中无患者出现下肢静脉血栓形成，差异无有统计学意义（P>0.05）。结论：FNB与ACB在全膝关节置换术后镇痛方面无明显差异，但ACB组较好的保留患者术后早期股四头肌肌力，对于术后功能锻炼和快速康复有较积极的作用，两种神经阻滞方式对患者VTE风险的影响相同。 |
| 英文摘要: |
| ABSTRACT Objective: To investigate the effects of femoral nerve block (FNB) and adductor canal block (ACB) on lower limb venous thrombosis after total knee arthroplasty. Methods: 40 patients who planned to undergo total knee arthroplasty under general anesthesia from March 2019 to April 2019 were randomly divided into FNB group and ACB group. Postoperative pain scores at rest and during activity, muscle strength of quadriceps femoris and deep venous thrombosis were evaluated in the two groups. Results: There was no significant difference in VAS scores between the two groups of patients with local pain in the affected area at 2, 6, 12, 24, 48, and 72 hours after surgery(P>0.05). The quadriceps muscle strength of the patients in the ACB group was significantly higher than that of the FNB group at 2, 6, 12, 24, and 48 hours after surgery(P<0.05), and there was no significant difference in quadriceps muscle strength between the two groups at 72 hours after surgery(P>0.05). The first straight leg raising time in the ACB group was (4.5±4.6) h after surgery, which was significantly lower than the first straight leg raising time in the FNB group after surgery(25.6±12.6) h. There was a statistically significant difference between the two groups(P<0.05). At 72 hours after surgery, two groups of patients were given double lower limb vascular ultrasound. Two of the 19 patients in the FNB group had venous thrombosis of the lower extremities, all of which were venous thrombosis of the muscle space; none of the 20 patients in the ACB group had venous thrombosis of the lower extremities, and the difference was not statistically significant (P>0.05). Conclusion: There was no significant difference between FNB and ACB in postoperative analgesia after total knee arthroplasty, but the ACB group had a better retention of the early postoperative quadriceps muscle strength, which had a positive effect on postoperative functional exercise and rapid recovery. Both FNB and ACB had the same effect on the risk of VTE. |
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