| 杨曙光,陈超,万里.超声引导经骶后孔骶丛阻滞在骨科手术中的应用.骨科,2018,9(1): 46-49. |
| 超声引导经骶后孔骶丛阻滞在骨科手术中的应用 |
| Application of ultrasound-guided sacral plexus block via posterior sacral foramen for orthopedic surgeries |
| 投稿时间：2017-10-18 |
| DOI：10.3969/j.issn.1674-8573.2018.01.010 |
| 中文关键词: 骶后孔 骶丛 超声检查 髋 臀肌挛缩症 |
| 英文关键词: Posterior sacral foramen Sacral plexus Ultrasonography Hip Gluteal muscle contracture |
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| 中文摘要: |
| 目的 初步总结超声引导下经骶后孔入路骶丛神经阻滞在骨科手术中的应用。方法 回顾性分析我院2016年8月至2017年4月期间采用超声引导下神经阻滞麻醉，复合或单凭骶后孔入路骶丛阻滞的29例病例，包括人工髋关节置换术27例、关节镜下臀肌挛缩松解术1例及臀部包块切除术1例，总结阻滞方法、麻醉效果、骶后孔局部麻醉药物容量以及并发症情况。结果 27例人工髋关节置换术病人中，有3例术中追加舒芬太尼后仍有不适而改为复合喉罩全身麻醉，阻滞成功率为88.9%，剩余手术均在神经阻滞下完成，为提高病人舒适度，均复合轻度镇静。经骶后孔入路骶丛阻滞可在超声引导下准确、快速地进行，病人手术结束后苏醒室中的疼痛视觉模拟量表（visual analogue scale, VAS）评分为（0.8±0.6）分，与术前的（5.7±1.0）分相比，差异具有统计学意义（P＜0.05）。骶后孔局部麻醉药物容量为（15.6±2.9） ml，术后随访未出现局部麻醉药物中毒、骶尾部血肿、蛛网膜下腔阻滞或术后感觉运动异常。结论 超声引导下经骶后孔骶丛阻滞，可安全应用于骨科髋部及臀部手术，麻醉及镇痛效果满意。 |
| 英文摘要: |
| Objective To summarize the application of ultrasound-guided sacral plexus block via posterior sacral foramen for orthopedic surgeries. Methods A retrospective analysis was made on the clinical data of 29 patients including 27 cases of artificial hip replacement, 1 case of arthroscopic gluteus contracture release and 1 case of hip mass resection from August 2016 to April 2017. All patients underwent nerve block anesthesia, combined or alone with sacral plexus block via posterior sacral foramina approach. The method, effect, volume of local anesthetics and complications were summarized. Results The laryngeal masks were set in 3 cases of the 27 artificial hip replacement because of the discomfort feeling after administration of sufentanil, with the blocking success rate being 88.9%. The rest patients were subjected to nerve block anesthesia only, with moderate sedation to improve the comfort of patients. The ultrasound-guided sacral plexus block through posterior sacral foramen was an accurate and fast technique with VAS score being decreased from 5.7±1.0 (preoperation) to 0.8±0.6 (postoperation), which had the significant differences. The local anesthetic volume for sacral plexus was (15.6±2.9) ml. There was no performance of local anesthetics systemic toxicity, sacrococcygeal hematoma, subarachnoid anesthesia or abnormal sensory and motor block. Conclusion Ultrasound-guided sacral plexus block via posterior sacral foramen can be safely applied to the hip and sacrococcygeal surgeries with satisfied anesthetic and analgesic effects. |
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