神经阻滞联合全身麻醉在老年胫骨平台骨折患者关节镜下微创治疗中的应用效果研究

摘要/Abstract

摘要： 目的研究神经阻滞联合全身麻醉在老年胫骨平台骨折患者关节镜下微创治疗中的应用效果。方法选取2019年5月~2021年10月新疆建设兵团第二师焉耆医院收治的126例老年胫骨平台骨折患者作为研究对象,根据随机数表法分为全麻组和神经阻滞组,各63例。所有患者都给予关节镜下微创切开内固定手术,全麻组给予单纯全身麻醉,神经阻滞组在对照组治疗的基础上给予超声引导下神经阻滞麻醉。比较两组患者神经阻滞相关指标、手术时间、术中出血量、术后住院时间、骨折愈合时间、术后VAS评分以及膝关节优良率。结果神经阻滞组患者感觉神经阻滞维持时间、运动神经阻滞维持时间、术后镇痛维持时间均长于全麻组,差异有统计学意义（P<0.05）;两组患者手术时间、术中出血量比较,差异无统计学意义（P>0.05）;神经阻滞组患者术后住院时间、骨折愈合时间短于全麻组,差异有统计学意义（P<0.05）;神经阻滞组患者术后1 d、术后3 d、术后7 d疼痛视觉模拟评分法（VAS）评分均低于全麻组,差异有统计学意义（P<0.05）;神经阻滞组患者术后3个月、术后6个月的膝关节优良率均高于全麻组,差异有统计学意义（P<0.05）。结论超声引导下神经阻滞应用于老年胫骨平台骨折患者关节镜下的微创治疗能有效延长麻醉与镇痛维持时间,促进患者康复,且不会增加手术时间与术中出血量,还可缓解疼痛,改善患者的膝关节功能,值得临床应用。

关键词: 全身麻醉, 超声引导下神经阻滞, 老年人, 胫骨平台骨折, 关节镜, 镇痛维持时间, 膝关节功能

Abstract: Objective To explore and compare the application effect of two compound anesthesia methods in the minimally invasive treatment of elderly patients with tibial plateau fractures under arthroscopy. Methods A total of 126 elderly patients with tibial plateau fracture admitted to Yanqi Hospitalof the Second Division of Xinjiang Construction Corps from May 2019 to October 2021 were selected as the research objects. According to the random number table method, they were divided into general anesthesia group and nerve block group, 63 cases in each group. All patients were treated with arthroscopic minimally invasive incision and internal fixation. The general anesthesia group was treated with simple general anesthesia, and the nerve block group was treated with ultrasound-guided nerve block anesthesia on the basis of the control group. The nerve block related indexes, operation time, intraoperative blood loss, postoperative hospital stay, fracture healing time, postoperative VAS score and excellent and good rate of knee joint were compared between the two groups. Results The maintenance time of sensory nerve block, motor nerve block and postoperative analgesia in nerve block group were significantly higher than those in general anesthesia group (P<0.05). There was no significant difference in operation time and intraoperative blood loss between the two groups (P>0.05). The postoperative hospital stay and fracture healing time of the nerve block group were lower than those of the general anesthesia group, and the differences were statistically significant (P<0.05). The visual analogue scale (VAS) scores of the nerve block group at 1 day, 3 days and 7 days after operation were lower than those of the general anesthesia group, and the differences were statistically significant (P<0.05). The excellent and good rates of knee joint in nerve block group at 3 months and 6 months after operation were higher than those in general anesthesia group, and the differences were statistically significant (P<0.05). Conclusion Ultrasound-guided nerve block in the minimally invasive treatment of elderly patients with tibial plateau fracture under arthroscopy can effectively prolong the maintenance time of anesthesia and analgesia, promote the rehabilitation of patients, and will not increase the operation time and intraoperative blood loss, but also can relieve pain, improve the knee function of patients, which is worthy of clinical application.

Key words: general anesthesia, ultrasound-guided nerve block, elderly, tibial plateau fracture, arthroscopy, analgesia maintenance time, knee joint function

中图分类号:

R614

唐朝虎, 樊鹏鑫. 神经阻滞联合全身麻醉在老年胫骨平台骨折患者关节镜下微创治疗中的应用效果研究[J]. 中华养生保健, 2022, 40(22): 4-7.

TANG Chao-hu, FAN Peng-xin. Application Effects of Two Compound Anesthesia Methods in Arthroscopic Minimally Invasive Treatment of Elderly Patients with Tibial Plateau Fractures[J]. ZHONGHUA YANGSHENG BAOJIAN, 2022, 40(22): 4-7.

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