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髂筋膜间隙阻滞和腰方肌阻滞在骨科手术中的应用及批判性评价

Applications and critical evaluation of fascia iliaca compartment block and quadratus lumborum block for orthopedic procedures.

作者信息

Plečko Mihovil, Bohaček Ivan, Tripković Branko, Čimić Mislav, Jelić Mislav, Delimar Domagoj

机构信息

Department of Orthopaedic Surgery, University Hospital Centre Zagreb, School of Medicine, University of Zagreb, Zagreb, Croatia.

出版信息

Acta Clin Croat. 2019 Jun;58(Suppl 1):108-113. doi: 10.20471/acc.2019.58.s1.16.

Abstract

Anterior section of the hip joint capsule is innervated by femoral nerve and obturator nerve, and posterior section is innervated by the nerve to quadratus femoris muscle and occasionally by the superior gluteal (posterolateral region) and sciatic nerve (posterosuperior region). One of the regional anesthesia options for hip surgery is the fascia iliaca compartment block (FICB) that affects nerves important for hip innervation and sensory innervation of the thigh - femoral, obturator and lateral femoral cutaneous nerve. FICB can be easily performed and is often a good solution for management of hip fractures in emergency departments. Its use reduces morphine pre-operative requirement for patients with femoral neck fractures and can also be indicated for hip arthroplasty, hip arthroscopy and burn management of the region. Quadratus lumborum block (QLB) is a block of the posterior abdominal wall performed exclusively under ultrasound guidance, with still unclarified mechanism of action. When considering hip surgery and postoperative management, the anterior QLB has shown to reduce lengthy hospital stay and opioid use, it improves perioperative analgesia in patients undergoing hip and proximal femoral surgery compared to standard intravenous analgesia regimen, provides early and rapid pain relief and allows early ambulation, thus preventing deep vein thrombosis and thromboembolic complications etc. However, some nerve branches responsible for innervation of the hip joint are not affected by QLB, which has to be taken into consideration. QLB has shown potential for use in hip surgery and perioperative pain management, but still needs to be validated as a reliable treatment approach.

摘要

髋关节囊前部由股神经和闭孔神经支配,后部由股方肌神经支配,偶尔也由臀上神经(后外侧区域)和坐骨神经(后上部区域)支配。髋关节手术的区域麻醉选择之一是髂筋膜间隙阻滞(FICB),它会影响对髋关节神经支配和大腿感觉神经支配很重要的神经——股神经、闭孔神经和股外侧皮神经。FICB操作简便,通常是急诊科处理髋部骨折的良好方法。它的使用可减少股骨颈骨折患者术前对吗啡的需求,也可用于髋关节置换术、髋关节镜检查及该区域的烧伤处理。腰方肌阻滞(QLB)是一种仅在超声引导下进行的后腹壁阻滞,其作用机制尚不清楚。在考虑髋关节手术及术后管理时,前路QLB已显示可缩短住院时间和减少阿片类药物的使用,与标准静脉镇痛方案相比,它可改善髋关节和股骨近端手术患者的围手术期镇痛效果,提供早期快速的疼痛缓解并允许早期活动,从而预防深静脉血栓形成和血栓栓塞并发症等。然而,负责髋关节神经支配的一些神经分支不受QLB影响,这一点必须考虑到。QLB已显示出在髋关节手术和围手术期疼痛管理中的应用潜力,但仍需验证其作为一种可靠治疗方法的有效性。

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