摘要
目的比较股三角阻滞和收肌管阻滞在全膝关节置换术后的镇痛疗效。方法检索中国知网、万方数据知识服务平台、维普、中华医学期刊全文数据库、PubMed、Embase、the Cochrane library数据库中有关股三角阻滞与收肌管阻滞在全膝关节置换术后镇痛疗效比较的临床研究,检索时间从建库至2024年10月。提取膝关节疼痛评分、吗啡消耗量、股四头肌肌力、术后"起立-行走"计时测试(timed up-and-go test,TUGT)及术后并发症。采用改良Jadad评分量表评价纳入文献的方法学质量。使用Stata18.0统计学软件进行meta分析。结果共9项随机对照试验中的670例患者纳入meta分析。股三角阻滞组333例,平均年龄60.6~72.3岁;收肌管阻滞组337例,平均年龄61.7~73.5岁。7篇英文文献均为高质量文献,改良Jadad评分6~7分;2篇中文文献为低质量文献,改良Jadad评分为3分。Meta分析结果显示两组患者术后吗啡消耗量[SMD=0.13,95%CI(-0.45,0.71),P=0.658]、术后24 h膝关节静息痛评分[SMD=-0.35,95%CI(-1.48,0.78),P=0.545]、术后48 h膝关节静息痛评分[SMD=-0.56,95%CI(-1.71,0.60),P=0.347]、术后24 h TUGT[SMD=0.01,95%CI(-0.27,0.30),P=0.933]、术后48 h TUGT[SMD=0.04,95%CI(-0.61,0.69),P=0.905]、术后并发症发生率[RR=1.17,95%CI(0.56,2.45),P=0.669]的差异无统计学意义。收肌管阻滞组术后24 h股四头肌肌力大于股三角阻滞组,差异有统计学意义[WMD=-0.73,95%CI(-0.93,-0.53),P<0.001]。结论以股三角阻滞和收肌管阻滞为主的多模式镇痛方案均可有效缓解全膝关节置换术后疼痛,收肌管阻滞患者的术后早期肌力恢复更好。
Objective To compare the analgesic effect of femoral triangle block and adductor canal block after total knee arthroplasty.Methods Clinical studies comparing the analgesic efficacy of femoral triangle block and adductor canal block after total knee arthroplasty were retrieved from CNKI,Wanfang Data Knowledge Service Platform,VIP,Chinese Medical Journal Full-text Database,PubMed,Embase,and the Cochrane Library,with the retrieval time ranging from the establishment of the databases to October 2024.Data on knee pain scores,morphine consumption,quadriceps muscle strength,postoperative timed up-and-go test(TUGT),and postoperative complications were extracted.The modified Jadad scale was used to evaluate the methodological quality of the included literature.Meta-analysis was performed using Stata 18.0 statistical software.Results A total of 670 patients from 9 randomized controlled trials were included in the meta-analysis.There were 333 patients in the femoral triangle block group,with an average age of 60.6-72.3 years,and there were 337 patients in the adductor canal block group,with an average age of 61.7-73.5 years.All the 7 English articles were of high quality,and the modified Jadad score was 6-7 points.Two Chinese articles were of low quality and the modified Jadad score was 3.The results of meta-analysis showed that there were no statistically significant differences between the two groups in postoperative morphine consumption[SMD=0.13,95%CI(-0.45,0.71),P=0.658],postoperative 24h knee resting pain score[SMD=-0.35,95%CI(-1.48,0.78),P=0.545],postoperative 48h knee resting pain score[SMD=-0.56,95%CI(-1.71,0.60),P=0.347],postoperative 24h TUGT[SMD=0.01,95%CI(-0.27,0.30),P=0.933],postoperative 48h TUGT[SMD=0.04,95%CI(-0.61,0.69),P=0.905],and incidence of postoperative complications[RR=1.17,95%CI(0.56,2.45),P=0.669].The quadriceps strength of the adductor canal block group was greater than that of the femoral triangle block group at 24 h after operation,and the difference was statistically significant[WMD=-0.73,95%CI(-0.93,-0.53),P<0.001].Results Both femoral triangle block and adductor canal block can effectively relieve pain after total knee arthroplasty.Patients with adductor canal block have better muscle strength recovery in the early postoperative period.
作者
郝志敏
李雄娟
陈林
陈剑明
Hao Zhimin;Li Xiongjuan;Chen Lin;Chen Jianming(Department of Anesthesiology,Southern University of Science and Technology Hospital,Shenzhen 518055,China;Department of Anesthesiology,Shenzhen Second People's Hospital,Shenzhen 518035,China)
出处
《中华骨科杂志》
北大核心
2025年第15期1002-1008,共7页
Chinese Journal of Orthopaedics
基金
广东省医学会临床科研专项基金项目(2024HY-A3003)。
