超声引导下腘动脉与膝关节后囊间隙神经阻滞联合收肌管神经阻滞在老年单膝关节置换术中的应用

doi:10.3969/j.issn.1003-9198.2026.03.013

摘要/Abstract

摘要： 目的评估超声引导下腘动脉与膝关节后囊间隙神经阻滞(IPACK)联合收肌管神经阻滞(ACB)在老年单膝关节置换术中的应用效果。方法选择2023年5月至2025年5月接受单侧全膝关节置换术的老年患者118例,通过随机数表法将所有患者分为观察组和对照组,每组59例。对照组患者在超声引导下行近端ACB阻滞,观察组在对照组的基础上结合IPACK。记录2组麻醉时间、术后镇痛泵按压次数、舒芬太尼用量、下床时间。比较2组术后3、12、24、48 h的VAS评分及手术前后血清炎性因子水平、氧化应激指标水平、膝关节活动度、股四头肌肌力。观察2组不良反应发生情况。结果观察组术后下床时间早于对照组,术后镇痛泵按压次数、舒芬太尼用量、VAS评分、炎性因子水平、氧化应激指标水平均低于对照组,且膝关节活动度、股四头肌肌力大于对照组,差异均具有统计学意义(均P＜0.05)。2组术后不良反应发生率比较(11.9%比8.5%),差异无统计学意义(P＞0.05)。结论在老年单膝关节置换术中,超声引导下 IPACK 联合 ACB 较单纯近端 ACB镇痛效果更优、炎性与氧化应激反应更轻、膝关节功能恢复更好,且不会增加不良反应。

关键词: 全膝关节置换术, 腘动脉与膝关节后囊间隙神经阻滞, 收肌管神经阻滞, 膝关节活动度, 老年人

Abstract: Objective To evaluate the application effect of ultrasound-guided infiltration between the popliteal artery and capsule of the posterior knee (IPACK) combined with adductor canal block (ACB) in the elderly patients undergoing unilateral total knee arthroplasty (TKA). Methods A total of 118 elderly patients who underwent unilateral TKA from May 2023 to May 2025 were selected as the research subjects. They were randomly divided into the observation group and the control group using a random number table method, with 59 cases in each group. The control group received ultrasound-guided proximal ACB, while the observation group received IPACK on the basis of the control group. The anesthesia time, number of postoperative analgesic pump presses, sufentanil dosage, and time to get out of bed were recorded. The visual analog scale (VAS) scores were evaluated 3, 12, 24, and 48 h after surgery. Serum levels of inflammatory factors, oxidative stress indicators, knee joint range of motion (ROM), and quadriceps muscle strength before surgery and 48 h after surgery were compared between the two groups. The occurrence of adverse reactions was also observed. Results Compared with the control group, the time to get out of bed in the observation group was shorter. The number of postoperative analgesic pump presses, sufentanil dosage, VAS score, levels of inflammatory factors and oxidative stress indicators were significantly lower, while the knee joint ROM and quadriceps muscle strength were significantly higher in the observation group compared with those in the control group (all P＜0.05). There was no statistically significant difference in the incidence rate postoperative adverse reactions between the two groups (11.9% vs 8.5%, P＞0.05). Conclusions Ultrasound-guided IPACK combined with ACB can provide better analgesic effect, milder inflammatory and oxidative stress responses, and better knee joint function recovery compared with single proximal ACB in the elderly patients undergoing unilateral TKA, without increasing adverse reactions.

Key words: total knee arthroplasty, popliteal artery and knee joint posterior capsule space nerve block, adductor canal block, knee joint range of motion, aged

中图分类号:

R 687.4

殷春炜, 徐军, 董佩龙, 屈方方. 超声引导下腘动脉与膝关节后囊间隙神经阻滞联合收肌管神经阻滞在老年单膝关节置换术中的应用[J]. 实用老年医学, 2026, 40(3): 288-293.

YIN Chunwei, XU Jun, DONG Peilong, QU Fangfang. Application of ultrasound-guided popliteal artery and knee joint posterior capsule space nerve block combined with adductor canal block in elderly patients undergoing unilateral total knee arthroplasty[J]. Practical Geriatrics, 2026, 40(3): 288-293.

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