Objective: To compare the effect of sciatic nerve block (SNB) combined with continuted femoral nerve block (FNB) or continuted adductor canal block (ACB) on pain and motor function after total knee arthroplasty (TKA).
Methods: A total of 60 patients with TKA-treated osteoarthritis of the knee who met the selection criteria were enrolled between November 2020 and February 2021 and randomised allocated into the study group (SNB combined with continuted ACB) and the control group (SNB combined with continuted FNB), with 30 cases in each group. There was no significant difference in gender, age, body mass, height, body mass index, preoperative Hospital for Special Surgery (HSS) score, femoral tibial angle, and medial proximal tibial angle between the two groups ( P>0.05). The operation time, the initial time to the ground, the initial walking distance, and the postoperative hospital stay were recorded. At 2, 4, 6, 12, 24, and 48 hours after operation, the numerical rating scale (NRS) score was used to evaluate the rest pain around the knee joint, the quadriceps femoris muscle strength was evaluated by the freehand muscle strength method, and the knee flexion and extension angles were measured.
Results: There was no significant difference in the operation time and initial walking distance between the two groups ( P>0.05); the initial time to the ground and postoperative hospital stay of the study group were significantly shorter than those of the control group ( P<0.05). Except for the 48-hour postoperative NRS score of the study group, which was significantly lower than that of the control group ( P<0.05), there was no significant difference in the NRS scores between the two groups at the remaining time points ( P>0.05). The quadriceps femoris muscle strength from 4 to 24 hours postoperatively and the knee extension angle from 2 to 6 hours postoperatively of the study group were significantly better than those of the control group ( P<0.05); the differences in the quadriceps femoris muscle strength and knee extension and flexion angles between the two groups at the remaining time points were not significant ( P>0.05).
Conclusion: SNB combined with either continuted ACB or continuted FNB can effectively relieve pain in patients after TKA, and compared with combined continuted FNB, combined continuted ACB has less effect on quadriceps femoris muscle strength, and patients have better recovery of knee flexion and extension mobility.
目的: 比较坐骨神经阻滞（sciatic nerve block，SNB）联合持续股神经阻滞（femoral nerve block，FNB）或持续收肌管阻滞（adductor canal block，ACB）对人工全膝关节置换术（total knee arthroplasty，TKA）术后疼痛和运动功能的影响。.
方法: 共纳入2020年12月—2021年2月收治且符合选择标准的60例行TKA治疗的膝关节骨关节炎患者，随机分为研究组（SNB联合持续ACB）和对照组（SNB联合持续FNB），每组30例。两组患者性别、年龄、体质量、身高、身体质量指数及术前膝关节美国特种外科医院（HSS）评分、胫股角、胫骨近端内侧角等基线资料比较差异均无统计学意义（ P>0.05）。记录手术时间、初次下地时间、初次行走距离、术后住院时间；术后2、4、6、12、24、48 h，采用数字评分量表（NRS）评价患者膝关节周围静息疼痛情况，采用徒手肌力法评价股四头肌肌力变化，并测量膝关节屈曲及伸直角度。.
结果: 两组患者手术时间和初次行走距离比较差异无统计学意义（ P>0.05）；研究组初次下地时间和术后住院时间均明显短于对照组，差异有统计学意义（ P<0.05）。除术后48 h研究组NRS评分低于对照组（ P<0.05）外，其余时间点两组NRS评分比较差异无统计学意义（ P>0.05）。术后4～24 h研究组股四头肌肌力及2～6 h膝关节伸直角度均优于对照组，差异有统计学意义（ P<0.05）；其余时间点两组股四头肌肌力和膝关节屈伸角度比较差异均无统计学意义（ P>0.05）。.
结论: SNB联合持续ACB或持续FNB均可有效缓解TKA术后患者疼痛，与联合持续FNB相比，联合持续ACB对股四头肌肌力影响更小，患者膝关节屈伸活动恢复更好。.
Keywords: Total knee arthroplasty; adductor canal block; femoral nerve block; sciatic nerve block.