目的 比较超声引导下股三角区域阻滞（FTB）与收肌管阻滞（ACB）对患者术后自理能力（Barthel指数）及认知功能简易智力状态检查量表（MMSE）评分等的影响,以探讨不同区域阻滞麻醉方案的优化选择。方法 回顾性纳入88例确诊为老年膝关节退行性骨关节病且接受膝关节置换术患者,根据外周神经阻滞方式分为FTB组（46例）与ACB组（42例）,对比分析两组麻醉恢复指标、疼痛评分视觉模拟评分法（VAS）评分、MMSE和Barthel评分。结果 FTB组麻醉恢复时间短于ACB组,麻醉优良率高于ACB组（97.83% vs 83.33%, P<0.05）;FTB组麻醉后各时点（12 h、24 h、72 h）VAS评分（静息与活动状态）低于ACB组,MMSE和Barthel评分均高于ACB组,差异均有统计学意义（P<0.05）;FTB组的不良反应发生率明显低于ACB组（6.52% vs 26.19%, P<0.05）。结论 相较于ACB,FTB用于老年膝关节置换术更具优势,能促进麻醉恢复、减轻疼痛与认知影响、提升生活能力,且安全性更好,有助于加速术后康复。
Objective To compare the effects of ultrasound-guided femoral triangle block （FTB） versus adductor canal block （ACB） on patients' postoperative self-care ability （Barthel Index） and cognitive function Mini-Mental State Examination （MMSE） score. Methods A total of 88 elderly patients with degenerative knee osteoarthritis and receiving knee arthroplasty were retrospectively included and divided into the FTB group （n=46） and the ACB group （n=42） according to the method of peripheral nerve block. Indicators including anesthesia recovery, pain score visual analog scale （VAS） score, MMSE score, and Barthel Index were compared and analyzed between the two groups. Results The FTB group showed shorter anesthesia recovery time, higher excellent-good rate of anesthesia 97.83% vs 83.33%, P<0.05, lower resting and activity VAS scores at various time points after anesthesia （12 h, 24 h, and 72 h）, as well as higher MMSE and Barthel Index scores than the ACB group （P<0.05）. The incidence of adverse reactions was significantly lower in the FTB group than in the ACB group （6.52% vs 26.19%, P<0.05）. Conclusion Compared to ACB, FTB demonstrates greater advantages for elderly total knee arthroplasty. It promotes anesthesia recovery, alleviates pain and adverse cognitive impact, enhances self-care ability, offers better safety, and contributes to enhanced recovery after surgery.
[1] Lancaster P, Kocialkowski C, Pearce O, et al.Open lower limb fractures in the elderly[J]. Injury,2022,53(6):2268-2273.
[2] Loh B, Lim JA, Seah M, et al.Perioperative management of open fractures in the lower limb[J]. J Perioper Pract, 2022, 32(5):100-107.
[3] Gunther T, Farkashazi M, Mihalik G, et al.Functional outcome after lower limb periprosthetic fractures[J]. Injury, 2021,52(Suppl 1):S44-S47.
[4] Chen B, Tan M, Li Q, et al.Application of ultrasound-guided single femoral triangle and adductor canal block in arthroscopic knee surgery: a prospective, double-blind, randomized clinical study[J]. BMC Anesthesiol, 2024,24(1):182.
[5] 张泽,张建欣,王小倩,等.超声引导下股三角区域阻滞与收肌管阻滞对全膝关节置换患者术后镇痛效果对比[J]. 中国现代医药杂志,2020,22(5):15-19.
[6] Claireaux HA, Beaumont O, Griffin XL,et al.Open lower limb fractures in the UK trauma system: A multicentre prospective audit of current practice[J]. Injury, 2021,52(6):1374-1383.
[7] Tan M, Chen B, Li Q, et al.Comparison of analgesic effects of continuous femoral nerve block, femoral triangle block, and adductor block after total knee arthroplasty: a randomized clinical trial[J]. Clin J Pain, 2024,40(6):373-382.
[8] de Arzuaga CIS, Miguel M, Biarnés A, et al. Single-injection nerve blocks for total knee arthroplasty: femoral nerve block versus femoral triangle block versus adductor canal block-a randomized controlled double-blinded trial[J]. Arch Orthop Trauma Surg, 2023,143(11):6763-6771.
[9] 吕晓龙,黄久勤,王红旗.不同膝关节置换术对老年膝关节骨关节炎患者的临床疗效及功能恢复的影响[J]. 临床研究,2025,33(10):26-29.
[10] Sonawane K, Saxena S, Mistry T, et al.Pursuing an optimal regional analgesia strategy for total knee arthroplasty: a double-blind randomized controlled study of femoral triangle, adductor canal, and dual subsartorial blocks (FAD Trial)[J]. Cureus, 2025,17(8):e91147.
[11] Limanto CA, Gary ME, Saadat GH, et al.Combined upper-lower extremities fractures in the elderly[J]. Am Surg, 2023,89(8):3550-3553.
[12] 杨小晓,朱丽丽,张勇,等.超声引导下不同入路收肌管神经阻滞对膝关节置换术中血流动力学及麻醉质量影响的比较[J]. 新乡医学院学报,2025,42(10):853-858.
[13] Migliorini F, Betsch M, Bardazzi T, et al.Management of postoperative pain following primary total knee arthroplasty: a level I evidence-based Bayesian network meta-analysis[J]. Pharmaceuticals (Basel), 2025,18(4):556.
[14] Zheng F, Chen X, Huang J, et al.Study on risk factors of preoperative deep vein thrombosis in patients with lower limb fractures and construction and validation of risk prediction nomogram model[J]. BMC Surg, 2024,24(1):408.
[15] Fan Chiang YH, Wang MT, Chan SM, et al.Motor-sparing effect of adductor canal block for knee analgesia: an updated review and a subgroup analysis of randomized controlled trials based on a corrected classification system[J]. Healthcare (Basel), 2023,11(2):210.
[16] Grunow JJ, Hartmann L, Ulm B, et al.Reliability of pre-admission patient-reported outcome measures postoperatively assessed via proxies: a prospective, multicenter observational study[J]. Crit Care, 2025, 29(1):200.
[17] Rodham P, Panteli M, Vun JSH, et al.Lower limb post-traumatic osteomyelitis: a systematic review of clinical outcomes[J]. Eur J Orthop Surg Traumatol, 2023, 33(5):1863-1873.
[18] Bai S, Hu A, Li W, et al.Comparing the analgesic effects of femoral triangle block and adductor canal block following total knee arthroplasty: a systematic review and meta-analysis[J]. BMC Anesthesiol, 2025, 25(1):202-206.
[19] Li X, Wang Y, Chen Y, et al.Comparison of femoral triangle block in combination with IPACK to local periarticular injection in total knee arthroplasty[J]. J Knee Surg, 2023,36(6):605-612.
