收肌管阻滞对全膝关节置换术镇痛效果分析

目的分析收肌管阻滞对全膝关节置换术镇痛效果。方法我院收治76例全膝关节置换术患者,收治时间为2021年6月-2022年6月,按照麻醉方式不同进行分组,收肌管阻滞组38例和股神经阻滞组38例。观察两组全膝关节置换术患者在术后不同时间点静息痛数字评分量表(NRS)、活动痛NR,观察两组全膝关节置换术患者术后不同时间点膝关节活动度情况。结果研究组与对照组静息疼痛VAS、动态疼痛VAS中,术后12h、24h及48h评分接近,组间对比均无显著差异(p>0.05);研究组患者术后24h、术后48h、术后72h膝关节活动度显著优于对照组,组间对比具有显著差异(p<0.05);研究组患者术后不良反应发生率为5.3%,对照组患者术后不良反应发生率为10.5%,数据对比无显著差异(x²值=0.181,p值=0.671)。结论 收肌管阻滞与股神经阻滞在全膝关节置换术后镇痛效果相当,但是收肌管阻滞患者在术后膝关节活动度均优于股神经阻滞,有助于患者全膝关节置换术后恢复。     

超声引导下股神经阻滞对全膝关节置换术患者术后镇痛的影响

目的 探讨全膝关节置换术患者采用超声引导下股神经组织进行术后镇痛的影响。方法 选取2017年9月-2021年4月采取全膝关节置换术治疗的150例患者作为研究对象,采用随机数字表法分为两组,各75例。对照组术后采取自控静脉镇痛,观察组术后采取超声引导下股神经阻滞。比较两组术后6 h、12 h、24 h内静息及活动时的镇痛效果[视觉模拟评分法(VAS)]、比较两组术前1 h、术后1 d、术后3 d的应激指标水平[血清皮质醇、促肾上腺皮质激素(ACTH)]水平、比较两组术后即刻、术后1 d、术后3 d的血液流变学(全血高切粘度、全血低切粘度、纤维蛋白原),统计两组不良反应发生情况。结果 观察组术后6 h、12 h、24 h的VAS评分较对照组同时点降低,组间、时点、组间时点交互比较(P<0.05);观察组术后1 d、术后3 d的血清皮质醇、ACTH水平均低于术前1 h,组间、时点、组间时点交互比较(P<0.05);观察组术后1 d、术后3 d的全血高切粘度、全血低切粘度及纤维蛋白原均低于术前1 h,组间、时点、组间时点交互比较(P<0.05);观察组不良反应总发生率低于对照...     

超声引导髂筋膜阻滞与股神经阻滞治疗全膝关节置换后疼痛的疗效比较

【摘要】 目的 探讨超声引导下股神经阻滞和髂筋膜阻滞治疗全膝关节置换后疼痛的疗效比较。方法 2016年7月至2019年5月,纳入84例年龄在20～80岁且美国麻醉师协会（ASA）分级为Ⅰ～Ⅱ计划进行单侧全膝关节置换患者。使用计算机随机化分组将患者分为2组。一组40例患者接受超声引导髂筋膜阻滞（FIB组）,另一组44例接受超声引导股神经阻滞（FNB组）。记录术后30 min和1、2、6、12和24 h的视觉模拟评分（VAS）和吗啡消耗剂量。填写手术后24 h,患者完成恢复质量（QoR- 40）问卷,同时记录术后恶心、呕吐不良反应。结果 与FNB组相比,FIB组术后24 h的VAS水平显著降低（P＜0.05）,其他1～12 h时间两组VAS评分没有明显差异。FNB组术后0～30 min的吗啡消耗剂量显著低于FIB组;然而,FIB组术后6～24 h的吗啡消耗剂量显著低于FNB组。术后24 h FIB组的QoR- 40评分显著高于FNB组（P＜0.05）。两组患者在术后恶心、呕吐不良反应方面没有显著差别。FNB组有1例患者术后发现手术侧大腿前侧感觉障碍。结论 股神经阻滞在术后最初30 min内提供了更有效的镇痛效果。6 h后,髂筋膜阻滞表现出更好的疼痛控制。且髂筋膜阻滞患者的术后恢复质量较高。     

股神经阻滞与收肌管阻滞应用于胫骨结节截骨联合内侧髌股韧带重建术后镇痛疗效及早期功能比较研究

目的：比较收肌管阻滞（adductor canal block,ACB）与股神经阻滞（femoral nerve block,FNB）用于胫骨结节截骨联合内侧髌股韧带重建术后的镇痛效果及早期功能。方法：前瞻性选取2019年2月至2021年9月在本院进行胫骨结节截骨联合内侧髌股韧带重建术的42例复发性髌骨脱位患者,采用随机数字表法分为ACB组（21例）和FNB组（21例）。ACB组患者行收肌管阻滞,FNB组患者行股神经阻滞,评价两组术后在镇痛效果、关节活动度、股四头肌肌力和功能恢复等指标方面的差异。结果：术后48 h静息状态和运动状态下的疼痛视觉模拟评分法（VAS）评分,ACB组（5.5±1.6和6.1±1.6）优于FNB组（6.3±1.8和6.9±1.8）,差异具有统计学意义（P<0.05）,术后12 h和24 h差异无统计学意义。术后12 h和24 h的股四头肌肌力方面,ACB组优于FNB组,差异有统计学意义（P<0.05）,术后48 h未见显著性差异。ACB组最大屈膝角度达到90°所需时间为2.8±0.5天,FNB组为4.2±0.6天,两组差异具有统计学意义（P=0.0...     

超声引导下收肌管阻滞联合静脉自控镇痛在老年全膝置换术后镇痛的作用

目的 探讨超声引导下收肌管阻滞联合静脉自控镇痛运用于全膝置换术后镇痛中的价值。方法 选取在全身麻醉下行全膝置换术的老年患者90例,按随机数字表法分成A、B两组(每组45例),A组开展静脉自控镇痛,B组除此之外采取超声引导下收肌管阻滞,记录手术前、手术后2 h、4 h、12 h、24 h两组患者的舒适度(BCS)评分、疼痛(VAS)评分、镇静(Ramsay)评分、膝关节活动度及不良反应等。结果 手术后不同时间点,B组VAS、Ramsay评分均低于A组(P<0.05),BCS评分、膝关节活动度均明显高于A组(P <0.05)。B组术后不良反应低于A组(P <0.05)。结论 超声引导下收肌管阻滞+静脉自控镇痛不仅术后镇痛效果更为突出,同时可提高患者舒适度,改善膝关节功能,减少不良反应出现。     

超声引导下神经阻滞对全膝关节置换术后患者镇痛效果分析

【摘要】 目的 对比分析超声引导下持续股神经阻滞对全膝关节置换术后患者的镇痛效果。方法 按照随机数表法将2017 年2 月至2018 年2 月黔南州中医医院收治的60 例行单侧全膝关节置换术治疗的患者分为观察组(30 例) 和对照组(30 例),其中观察组患者于全膝关节置换术后在超声引导下行持续股神经阻滞镇痛,对照组患者于全膝关节置换术后行静脉镇痛,对比两组患者术后4、8、12、24、48 h 静息状态下及术后24、48、72 h持续被动功能锻炼时的视觉模拟评分(visual analogue scale,VAS) ,术后2、3、4、5、6 d 股四头肌的肌力评分、术后2、3、4、5、6 d 的膝关节最大被动屈伸活动度以及术后不良反应发生率。结果 术后4、8、12、24、48 h静息状态下及术后24、48、72 h 持续被动功能锻炼时,观察组患者VAS 评分均明显低于对照组,P均< 0.01,差异具有统计学意义;术后2、3、4、5、6 d,观察组患者股四头肌肌力评分与对照组患者无明显差异,P均>0.05,差异无统计学意义;术后2、3、4 d,观察组患者膝关节最大被动屈伸活动度明显高于对照组,P 均<0.01,差异具有统计学意义,而术后5、6 d,观察组患者膝关节最大被动屈伸活动度与对照组无明显差异,P均>0.05,差异无统计学意义;治疗过程中,观察组患者不良反应发生率为3.33%,明显低于对照组患者的不良反应发生率40.00%,P<0.01,差异具有统计学意义。结论 超声引导下持续股神经阻滞可有效降低全膝关节置换术后患者的疼痛程度,镇痛效果显著,且不良反应发生率较低,对肌力无影响,有利于患者的早期功能恢复。     

超声引导下连续收肌管阻滞联合膝关节后囊间隙阻滞在老年患者全膝关节置换术中应用价值

目的 探讨超声引导下连续收肌管阻滞(ACB)联合膝关节后囊间隙(IPACK)阻滞在老年患者全膝关节置换术(TKA)中的应用价值.方法 选取中国科学技术大学附属第一医院自2020年1月至2021年1月收治的行择期单侧TKA的90例老年患者为研究对象.采用随机数字表法将患者分入3组,分别为单纯连续股神经阻滞组(F组)、单纯...     

股神经阻滞用于股骨干骨折术前镇痛临床观察

目的观察股神经阻滞对股骨干骨折患者术前搬动时的镇痛效果,为骨折患者术前提供更安全、有效的镇痛方法。方法股骨干骨折患者30例,ASAⅠ~Ⅱ级,手术当天随机分为三组。Ⅰ组常规肌注苯巴比妥0.1 g;Ⅱ组肌注哌替啶50 mg,异丙嗪25 mg;Ⅲ组用2%利多卡因15 m l行股神经阻滞。分别于搬动时进行视觉模拟评分(VAS)。结果VAS评分III组明显低于Ⅱ组(P<0.01),Ⅱ组明显低于Ⅰ组(P<0.01)。结论股神经阻滞对股骨干骨折患者的镇痛完善,并且操作简单易行,安全性高。     

超声引导下收肌管阻滞对半月板修复术患者镇痛效果及对股四头肌肌力影响

目的 探讨超声引导下收肌管阻滞对半月板修复术患者的镇痛效果及对股四头肌肌力的影响.方法 选取2021年5—7月运城市中心医院收治的84例接受半月板修复术的患者为研究对象.根据随机数字表法将患者分为观察组与常规组,每组各42例.常规组患者采用蛛网膜下腔阻滞手术治疗,观察组患者在常规组基础上进行超声引导下收肌管阻滞手术治疗...     

Revision total knee arthroplasty: a comparison of postoperative leg alignment after computer-assisted implantation versus the conventional technique

Accurate reconstruction of leg alignment is one important factor for long-term survival in total knee arthroplasty (TKA). Recent developments in computer-assisted surgery focused on systems improving TKA. The aim of the study is to compare the results of computer-assisted revision TKA with the conventional technique. We hypothize that a significantly better leg alignment and component orientation is achieved when using a navigation system for revision TKA. In a prospective study, two groups of 25 revision TKAs each were operated on using either a CT-free navigation system or the classical surgeon-controlled technique. The postoperative leg alignment was analysed on long-leg coronal and lateral X-rays. The mechanical limb axis was significantly better in the navigation-based group. Twenty-three patients (92%) in the computer-assisted group had a postoperative leg axis between 3° varus/valgus deviation, while 19 patients (76%) in the conventional group had a comparable result (p<0.05). Further, significant differences were seen for the coronal orientation of the femoral component. Computer-assisted revision TKA leads to a superior restoration of leg alignment compared with the conventional technique. Particularly the real-time presentation of the actual leg axis and the flexion and extension gaps is useful in revision TKA. Potential benefits in long-term outcome and functional improvement require additional investigation.     

Changes in femoral posterior condylar offset and knee flexion after PCL-substituting total knee arthroplasty: comparison of anterior and posterior referencing systems

Purpose

Anterior referencing and posterior referencing are two major techniques for positioning femoral components and balancing the sagittal plane during total knee arthroplasty (TKA). The purpose of this study was to evaluate the changes in medial and lateral posterior condylar offset (PCO) after bilateral TKA using anterior referencing (AR) or posterior referencing (PR) systems and compare the effect of the PCO changes on knee flexion.

Methods

Twenty female patients (mean age, 68.6 years) underwent bilateral TKA using the AR technique in one knee and the PR technique in the contralateral knee. Three-dimensional reconstructed computed tomographic images from the sagittal plane were used to evaluate PCO before and after arthroplasty. Knee Society scores and range of motion were evaluated postoperatively at a mean of 2.9 years.

Results

Postoperative medial and lateral PCOs were significantly greater (p < 0.001 and p = 0.048, respectively) in the AR group (30.9 ± 2.2 and 29.1 ± 1.5 mm, respectively) than those in the PR group (29.1 ± 2.7 and 27.3 ± 2.3 mm, respectively). In addition, the degree of change in the PCO after TKA was greater in the AR group than in the PR group. On the final follow-up, no differences in the degree of knee flexion were observed between the two groups (124.7° for AR and 124.5° for PR). Knee Society scores were similar in the two groups both preoperatively and postoperatively. On the final follow-up, individual changes in the medial and lateral PCO were not associated with changes in the knee flexion angle.

Conclusions

Restoration of PCO after TKA was more accurate with the PR technique than with the AR technique. However, the postoperative differences in PCO showed no correlation with changes in knee flexion 2 years after PCL-substituting TKA.

Level of evidence

Therapeutic study, Level I.

     

Periprosthetic supracondylar femoral fractures above total knee arthroplasty: comparison of the locking and non-locking plating methods

Purpose

The purpose of this study was to compare the results and complications of periprosthetic supracondylar femoral fracture treatment using locking or non-locking plates.

Methods

A locking compression plate was used in 14 patients, and a non-locking condylar buttress plate was used in 19 patients. There were no significant differences in the demographic data between the two groups. The primary healing rate and bone union time were compared. The Knee Society knee score and range of motion (ROM) were reviewed. The femorotibial angle and α and γ angles were measured using the Knee Society radiological evaluation method. The clinical and radiographic results, complications, and additional surgeries were compared between the two groups.

Results

Thirteen of 14 locking plating patients and 11 of 19 non-locking plating patients healed without any additional surgeries. There were no differences in the average bone union time, knee score, or ROM between the two groups. The alignment and position of the implants were better without a loss in the reduction angle of >3° in the locking plating group compared with the non-locking plating group. Locking plate fixation reduced the incidence of overall complications, non-union, malunion, loss of reduction, and additional surgeries compared with non-locking plate fixation.

Conclusion

Fixation of periprosthetic supracondylar femoral fractures with a locking plate provided satisfactory results with a low risk of complications and additional surgeries compared with fixation with a non-locking plate.

Level of evidence

III.     

One-stage versus two-stage exchange arthroplasty for infected total knee arthroplasty: a systematic review

Purpose

Infection complicating total knee arthroplasty (TKA) has serious implications. Traditionally the debate on whether one- or two-stage exchange arthroplasty is the optimum management of infected TKA has favoured two-stage procedures; however, a paradigm shift in opinion is emerging. This study aimed to establish whether current evidence supports one-stage revision for managing infected TKA based on reinfection rates and functional outcomes post-surgery.

Methods

MEDLINE/PubMed and CENTRAL databases were reviewed for studies that compared one- and two-stage exchange arthroplasty TKA in more than ten patients with a minimum 2-year follow-up.

Results

From an initial sample of 796, five cohort studies with a total of 231 patients (46 single-stage/185 two-stage; median patient age 66 years, range 61–71 years) met inclusion criteria. Overall, there were no significant differences in risk of reinfection following one- or two-stage exchange arthroplasty (OR ?0.06, 95 % confidence interval ?0.13, 0.01). Subgroup analysis revealed that in studies published since 2000, one-stage procedures have a significantly lower reinfection rate. One study investigated functional outcomes and reported that one-stage surgery was associated with superior functional outcomes. Scarcity of data, inconsistent study designs, surgical technique and antibiotic regime disparities limit recommendations that can be made.

Conclusion

Recent studies suggest one-stage exchange arthroplasty may provide superior outcomes, including lower reinfection rates and superior function, in select patients. Clinically, for some patients, one-stage exchange arthroplasty may represent optimum treatment; however, patient selection criteria and key components of surgical and post-operative anti-microbial management remain to be defined.

Level of evidence

III.

     

Arthrodesis of the knee after failed infected total knee arthroplasty

Infection after total knee arthroplasty (TKA) can be a challenging and difficult problem to treat. In selected patients, knee arthrodesis is a well-recognized salvage procedure after infected TKA. The authors retrospectively reviewed their experience with this treatment option, presenting 20 patients (8 women, 12 men), performed between 1990 and 2002. The average age was 67 years (range: 47–81 years) and the mean number of previous surgical procedures was 6 (range: 4–11 procedures). There were multiple indications for knee arthrodesis, including extensive bone or soft tissue loss, poor bone stock, and recurring infections. One-stage fusion was done in 7 knees while, on the other 13, arthrodesis was performed as two-stage fusions. The average clinical follow-up was 4.5 years (range: 2–11 years). 18 of the 20 patients were interviewed and graded using the Visual Analogue Scale (VAS) for pain, the Short Form-36 Health Survey (SF-36), and the Knee injury and Osteoarthritis Outcome Score (KOOS) questionnaire that has knee-related quality of life items. According to the VAS, the mean intensity was 3.4 points. 6 (33%) of the patients had no difficulty with the knee and 9 (50%) of them had mild or moderate difficulty. The SF-36 scores were similar to those for normative data for patients after TKA, with only the social functioning, role emotional, and physical functioning scores being lower and the role physical and social functioning scores being higher. Three of 20 fusions failed, whereas two knees became non-infected non-unions. In one, the knee infection persisted and required above-knee amputation. The two-stage arthrodesis gave the most predictable rate of fusion. Persistent infection and extensive bone stock losses led to failure even under the best circumstances. In our opinion, arthrodesis of the knee is a satisfactory salvage procedure following a failed TKA, and can provide reliable expectation for a stable, painless extremity for high-functioning patients who are able to walk.     

Functional outcome after computer-assisted versus conventional total knee arthroplasty: a randomized controlled study

Despite the frequent use of computer-assisted total knee arthroplasty (TKA) and better radiological results for coronal alignment reported in many studies, there is still no evidence of improved clinical outcomes when compared to conventional TKA. We compared alignment after navigated TKA and conventional TKA in 80 randomized patients. Seventy three patients were available for physical and radiological examination at 20 month after surgery. Both groups showed similar Knee Society Score results, with medians of 89 points (navigated 49–95 points, conventional 48–95 points, n.s.) in the Knee Score and 70 points (navigated 45–100 points, conventional 40–100 points, n.s.) in the Function Score. The median improvement in the Knee Society Knee Score was 45 points (−3 to 88 points) in the navigated group and 35 points (−13 to 62 points) in the conventional group (P = 0.03), and the Knee Society Function Score improvement was 15 points (−10 to 50 points) in the navigated group versus 10 points (−10 to 50 points) in the conventional group (n.s.). The current health state at follow-up using the EuroQuol questionnaire was similar in both groups, with medians of 67 points in the navigated group and 65 points in the conventional group. This investigation did show slightly greater functional improvement at short-term follow-up in the navigated TKA group. Longer follow-up will be required to assess the possible benefit of computer-assisted navigation.     

Mechanical axis-derived femoral component rotation in extramedullary total knee arthroplasty: a comparison between femoral transverse axis and transepicondylar axis

Purpose  

Correct rotational alignment of the femoral component is paramount to the success of total knee arthroplasty, but debate continues as to which method is the most reliable. The purpose of this study was to evaluate mechanical axis-derived rotational axis of the femoral component using an extramedullary femoral alignment guide system.