| 陈艳茹,向继林.收肌管阻滞对复发性髌骨脱位行胫骨结节截骨联合内侧髌股韧带重建术术后肌力及关节功能的影响[J].安徽医药,2026,30(11):2228-2232. |
| 收肌管阻滞对复发性髌骨脱位行胫骨结节截骨联合内侧髌股韧带重建术术后肌力及关节功能的影响 |
| Effects of adductor canal block on muscle strength and joint function after tibial tubercle osteotomy combined with medial patellofemoral ligament reconstruction for recurrent patellar dislocation |
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| DOI：10.3969/j.issn.1009-6469.2026.11.020 |
| 中文关键词: 髌骨脱位 神经肌肉阻滞 胫骨结节截骨 内侧髌股韧带重建 收肌管阻滞 肌力 关节功能 |
| 英文关键词: Patellar dislocation Neuromuscular blockade Tibial tubercle osteotomy Medial patellofemoral ligament reconstruc-tion Adductor canal block Muscle strength Joint function |
| 基金项目:四川省医学会青年创新课题( Q18065) |
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| 中文摘要: |
| 目的探讨收肌管阻滞对复发性髌骨脱位病人行胫骨结节截骨联合内侧髌股韧带(MPFL)重建术术后肌力及关节功能的影响。方法选取 2023年 7月至 2024年 6月在四川省骨科医院诊治的复发性髌骨脱位病人 96例，所有病人均接受胫骨结节截骨联合 MPFL重建术治疗，采用随机数表法将病人分为收肌管阻滞( SG)组和股神经阻滞( FN)组，均为 48例。比较两组病人术后 6、12、24 h运动神经阻滞情况，术后 3d和 1周后的股四头肌肌力，术后 12、24、48 h的疼痛程度，术前和出院前的膝关节功能变化，以及两组并发症发生情况。结果术后 6、12、24 h，SG组 Bromage评分分别为( 2.31±0.31)分、(1.46±0.29)分、(0.13±0.04)分， FN组分别为( 2.02±0.35)分、(1.78±0.21)分、(0.32±0.07)分， SG组各时间点评分均高于 FN组( P<0.05)。术后 3d和术后 1周， SG组股四头肌肌力较 FN组高( P<0.05)。术后 48 h，SG组静息视觉模拟评分法( VAS)(2.15±0.42)分、屈膝 VAS评分(2.86±0.51)分，均低于 FN组的( 3.68±0.53)分、(4.72±0.64)分( P<0.05)。出院前两组髌股关节功能( KPS)、膝关节功能评分(LKSS)均较术前明显提升； SG组术前 KPS(53.62±6.28)分、 LKSS(63.25±6.18)分，出院前分别为( 62.65±4.16)分、(73.18±5.61)分； FN组术前 KPS(54.18±6.72)分、 LKSS 62.17±6.02)分，出院前分别为( 61.45±4.41)分、(74.28±5.29)分，组间比较差异无统计学意义( P>0.05)。 SG组并发症发生率为 8.32%，FN组为 14.58%，差异无统计学意义(P>0.05)。结论收肌管阻滞应用于胫骨结节截骨联合 MPFL重建术，可减轻术后运动阻滞，提升股四头肌肌力，并降低复发性髌骨脱位病人术后疼痛。 |
| 英文摘要: |
| Objective To explore the effects of adductor canal block on muscle strength and joint function in patients with recurrentdislocation of patella after tibial tubercle osteotomy combined with medial patellofemoral ligament (MPFL) reconstruction.Methods A total of 96 patients with recurrent dislocation of patella who underwent tibial tubercle osteotomy combined with MPFL reconstruction atSichuan Province Orthopedic Hospital from July 2023 to June 2024 were enrolled. According to random number table method, the pa-tients were divided into an adductor canal block group (sartorial group or SG group, n=48) and an FN group (femoral nerve block group, n=48). The two groups were compared in terms of motor nerve block at 6, 12 and 24 h postoperatively, muscle strength of quadriceps at3 d and 1 week postoperatively, pain severity at 12, 24 and 48 h postoperatively, changes of knee joint function before surgery and be-fore discharge, and the occurrence of complications.Results At 6, 12 and 24 h postoperatively, Bromage scores in SG group were sig-nificantly higher than those in FN group at all time points [(2.31±0.31) points, (1.46±0.29) points, (0.13±0.04) points vs. (2.02±0.35) points, (1.78±0.21) points, (0.32±0.07) points; P<0.05]. At 3 d and 1 week postoperatively, muscle strength of quadriceps in SG group was greater than that in FN group (P<0.05). At 48 h postoperatively, visual analog scale (VAS) scores under resting conditions andkneeling states in SG group were lower than those in FN group [(2.15±0.42) points, (2.86±0.51) points vs. (3.68±0.53) points, (4.72± 0.64) points; P<0.05]. Before discharge, both the Kujala Patellofemoral Score (KPS) and the Lysholm Knee Scoring Scale (LKSS) scoreswere significantly increased compared with those before surgery in both groups, but there was no significant difference in scores of KPSand LKSS between SG group and FN group before surgery and before discharge [before surgery: (53.62±6.28) points, (63.25±6.18)points vs. (54.18±6.72) points, (62.17±6.02) points; before discharge: (62.65±4.16) points, (73.18±5.61) points vs. (61.45±4.41) points, (74.28±5.29) points; P>0.05]. There was no significant difference in the incidence of complications between SG group and FN group (8.32% vs. 14.58%, P>0.05).Conclusion Adductor canal block applied in tibial tubercle osteotomy combined with MPFL reconstruc-tion can alleviate postoperative motor block, improve muscle strength of quadriceps and relieve postoperative pain in patients with re-current dislocation of patella. |
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