目的:比较单纯椎管内麻醉和髂筋膜腔联合阻滞(FICB)对前外侧小切口全髋关节置换术(THA)的效果OCM)。
方法:2019年1月至2020年10月,对单侧全髋关节置换术患者分别采用椎管内麻醉联合超声引导髂筋膜腔阻滞(A组30例)和单纯椎管内麻醉(B组30例)。两组术后静脉镇痛相同。操作时间,出血量,臀中肌的脱皮程度,股骨大转子的分裂,术后髋关节视觉分析量表(VAS),术前、术后48小时股四头肌和髋关节外展肌肌力,观察比较两组患者术后髋关节功能Harris评分。
结果:所有患者均获随访48~62周,平均(54.2±4.0)周。切口长度,A组手术时间、术中出血量明显低于B组(P<0.05)。A组术后24h血红蛋白水平明显高于B组(P<0.05)。术后48hA组髋关节外展肌肌力明显高于B组(P<0.05)。A组臀中肌剥离程度明显低于B组(P<0.05)。A组术后8、12、24h的VAS评分明显低于B组(P<0.05);A组术后2、8周的Harris评分明显高于B组(P<0.05)。
结论:在侧卧位OCM入路THA中应用超声引导髂筋膜室阻滞可明显缩短手术时间,减少出血量,减少髋关节周围的创伤,如手术中臀中肌剥离,改善患者术后早期疼痛,OCM方法的临床操作和患者术后的快速恢复。
OBJECTIVE: To compare the effects of simple intraspinal anesthesia and combined fascia iliaca compartment block(FICB) on total hip arthroplasty(THA) through anterior lateral small incision (orthop dische chirurgie München, OCM).
METHODS: From January 2019 to October 2020, patients undergoing unilateral total hip arthroplasty were treated with intraspinal anesthesia combined with ultrasound-guided fascia iliaca compartment block(30 cases in group A) and simple intraspinal anesthesia(30 cases in group B). Two groups were treated with the same intravenous analgesia after operation. The operation time, the amount of bleeding, the peeling degree of middle gluteal muscle, the splitting of greater trochanter of femur, the visual analysis scale (VAS) of hip joint after operation, the abductor muscle strength of quadriceps femoris and hip joint before and 48 hours after operation, and the Harris score of hip joint function after operation were observed and compared between two groups.
RESULTS: All patients were followed up for 48 to 62 weeks with an average of (54.2±4.0) weeks. The incision length, operation time and intraoperative bleeding in group A were significantly lower than those in group B (P<0.05). The level of hemoglobin 24 hours after operation in group A was significantly higher than that in group B (P<0.05). The abductor muscle strength of hip joint in group A was significantly higher than that in group B 48 hours after operation (P<0.05). The degree of middle gluteal muscle dissection in group A was significantly lower than that in group B (P<0.05). The VAS of group A at 8, 12 and 24 hours after operation was significantly lower than that of group B (P<0.05);The Harris score in group A was significantly higher than that in group B at 2 and 8 weeks after operation (P<0.05).
CONCLUSIONS: The application of ultrasound-guided fascia iliaca compartment block in lateral position OCM approach THA can significantly shorten the operation time, reduce the amount of bleeding, reduce the perihip trauma such as the peeling of middle gluteal muscle during operation, and improve the early postoperative pain of patients, which is conducive to the clinical operation of OCM approach and the rapid postoperative recovery of patients.