Chen Lingmin, Liu Jin, Yang Jing, Zhang Yanzi, Liu Yue
From the Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China.
Reg Anesth Pain Med. 2016 Mar-Apr;41(2):158-63. doi: 10.1097/AAP.0000000000000350.
Selecting an appropriate anesthetic technique for patients with ankylosing spondylitis undergoing hip surgery is challenging because of a potentially difficult airway, the risk of cardiovascular and respiratory complications, and the technical difficulty of performing central neuraxial blocks in patients with ankylosing spondylitis. Our objective was to report a case in which combination neural blockade was used successfully in an elderly patient with ankylosing spondylitis undergoing hip fracture surgery. In addition, a literature review of the anesthetic techniques reported for these patients was conducted.
A 70-year-old man with severe ankylosing spondylitis and respiratory dysfunction was scheduled for a closed intertrochanteric fracture reduction and internal fixation. Combined fascia iliaca block and parasacral sciatic nerve block were used successfully for the surgery. Postoperative analgesia was accomplished by continuous fascia iliaca block.
According to the literature review, general anesthesia is the most commonly performed anesthetic technique for patients with ankylosing spondylitis undergoing hip surgeries. Special intubation techniques and cautious airway management were very important for these patients. Although both general anesthesia and central neuraxial blockade pose considerable risks to the patients, this case report suggests that combined fascia iliaca block and sciatic nerve block might be a promising option.
为强直性脊柱炎患者进行髋关节手术选择合适的麻醉技术具有挑战性，这是因为气道可能存在困难、有心血管和呼吸并发症风险，以及在强直性脊柱炎患者中实施中枢神经阻滞存在技术难度。我们的目的是报告一例在接受髋部骨折手术的老年强直性脊柱炎患者中成功使用联合神经阻滞的病例。此外，还对报道的用于这些患者的麻醉技术进行了文献综述。
一名70岁患有严重强直性脊柱炎和呼吸功能障碍的男性计划进行闭合性股骨转子间骨折复位内固定术。联合髂筋膜阻滞和骶旁坐骨神经阻滞成功用于该手术。术后镇痛通过持续髂筋膜阻滞完成。
根据文献综述，全身麻醉是强直性脊柱炎患者进行髋关节手术最常用的麻醉技术。特殊的插管技术和谨慎的气道管理对这些患者非常重要。虽然全身麻醉和中枢神经阻滞都给患者带来相当大的风险，但本病例报告表明联合髂筋膜阻滞和坐骨神经阻滞可能是一个有前景的选择。
