1.Ultrasound-guided needle knife release with different pathways for carpal tunnel syndrome: a randomized controlled trial.
Zhaobao LI ; Song HE ; Longyu XIE ; Hehuizi BAI ; Dejun CHENG ; Wenchao ZHANG ; Mingyong HUANG
Chinese Acupuncture & Moxibustion 2025;45(1):21-26
OBJECTIVE:
To evaluate the clinical efficacy of ultrasound-guided needle knife release with different pathways for carpal tunnel syndrome (CTS).
METHODS:
Sixty CTS patients were randomly divided into a transverse group and a longitudinal group, with 30 patients in each group. The transverse group received the needle knife release under ultrasound above and below the median nerve along the short axis, while the longitudinal group received the needle knife release under ultrasound above the median nerve along the long axis. The patients' visual analogue scale (VAS) scores, Levine scores, and median nerve cross-section area (CSA) were assessed before treatment, on the 7th, 14th, and 30th days after treatment. The median nerve conduction indexes (motor conduction: latency [Lat], amplitude[Amp], motor conduction velocity [MCV]; sensory conduction: Lat, Amp, sensory conduction velocity [SCV]) were evaluated before treatment and on the 30th day after treatment.
RESULTS:
Compared before treatment, the VAS scores, Levine scores, and median nerve CSA were reduced in both groups on the 7th, 14th, and 30th days after treatment (P<0.05); the transverse group showed lower VAS and Levine scores and smaller CSA than those in the longitudinal group (P<0.05). On the 30th day after treatment, motor and sensory Lat was reduced (P<0.05), motor and sensory Amp was increased (P<0.05), and MCV and SCV were faster (P<0.05) in both groups. The transverse group had shorter Lat, higher Amp, and faster MCV and SCV than those in the longitudinal group (P<0.05).
CONCLUSION
The ultrasound-guided needle knife release with transverse and longitudinal pathways could both effectively alleviate pain and improve median nerve conduction in CTS patients, with the transverse pathway showing superior efficacy to longitudinal pathway.
Humans
;
Carpal Tunnel Syndrome/therapy*
;
Female
;
Middle Aged
;
Male
;
Adult
;
Median Nerve/physiopathology*
;
Acupuncture Therapy/instrumentation*
;
Treatment Outcome
;
Neural Conduction
;
Aged
;
Ultrasonography
2.Protective effect of Sini Decoction in attenuating cryopreservation-induced injury of rats' sciatic nerves based on apoptosis and oxidative stress.
Kang YANG ; Jun LIU ; Lin-Lan ZHOU ; Yun-Xiao LIU ; Chun-Lin DU ; Xiao-Zhi MEI ; Ying-Ru HUANG
China Journal of Chinese Materia Medica 2025;50(5):1351-1362
Cryopreservation is the primary technique for in vitro preservation of allogeneic tissue. However, its success is often hindered by factors such as low temperature, ischemia, and hypoxia. This study investigated the potential of Sini Decoction, known for its antioxidant and anti-apoptotic properties, to reduce cryopreservation-induced injury in rats' sciatic nerves. Sini Decoction was prepared according to the Chinese Pharmacopoeia, and its cytotoxicity on Rsc96 cells was assessed by using the CCK-8 method. Sini Decoction at concentrations of 4, 8, and 16 mg·mL~(-1), termed as low-(SL), medium-(SM), and high-(SH) doses group, was used for cryopreservation of rats' sciatic nerves. A normal control(NC) group and a fresh nerve control(fresh) group were set. Flow cytometry and TUNEL staining were used to detect the apoptosis of neural tissue cells after cryopreservation. Western blot was used to detect the expression of apoptosis-related proteins(Bcl-2, Bax, caspase-3, and caspase-8) and nerve regeneration proteins(NGF and BDNF) in vitro after cryopreservation. Oxidative damage of neural tissue after cryopreservation was evaluated by measuring levels of GSH, SOD, MDA, ROS, and ATP. Cryopreserved nerves were then used for allogeneic transplantation. One week after transplantation, CD4~+ and CD8~+ fluorescent double staining assessed inflammatory cell invasion in the transplanted nerve segment, and ELISA evaluated the expression of serum inflammatory factors(IL-1, IFN-γ, and TNF-α) in recipients. Twenty weeks after transplantation, electrophysiology and NF200 neurofilament staining were used to evaluate nerve regeneration. RESULTS:: showed that Sini Decoction at concentrations of below 32 mg·mL~(-1) exhibited no cytotoxicity to Rsc96 cells. During in vitro nerve cryopreservation, Sini Decoction significantly reduced cell apoptosis, ROS, and MDA production compared to the NC group. In the SH group, the protein expression of NGF and BDNF in vitro, as well as ATP, SOD, and GSH production, were significantly increased. In the rejection reaction one week after transplantation, compared to the fresh nerve transplantation group, the SL and SM groups showed reduced CD4~+ and CD8~+ T cell invasion in the transplanted nerve segment and down-regulated IL-1, IFN-γ, and TNF-α expression in recipient serum. Twenty weeks after transplantation, the electrophysiological test results of CMAP, NCV, and NF200 neurofilament protein fluorescent staining in the SM and SH groups were superior to those in the NC and fresh groups. These findings indicate that Sini Decoction offers protective benefits in the cryopreservation of rats' sciatic nerves and holds significant potential for the in vitro preservation of tissue and organs.
Animals
;
Apoptosis/drug effects*
;
Rats
;
Oxidative Stress/drug effects*
;
Sciatic Nerve/cytology*
;
Cryopreservation
;
Drugs, Chinese Herbal/administration & dosage*
;
Male
;
Rats, Sprague-Dawley
;
Protective Agents/pharmacology*
3.Application of elbow skin fold extension line in extreme elbow flexion in ulnar Kirschner wire insertion of extended supracondylar humeral fractures in children.
Xu LIU ; Wei WU ; Yuzhou SHAN ; Guanghui YANG ; Ming CHEN
Chinese Journal of Reparative and Reconstructive Surgery 2025;39(1):70-74
OBJECTIVE:
To discuss the elbow skin fold extension line in Kirschner wire internal fixation of extended supracondylar humeral fractures in children.
METHODS:
The clinical data of 58 children with extended supracondylar fractures of the humerus who met the selection criteria between August 2021 and July 2024 were retrospectively analyzed. In 28 cases, needle placement of medial epicondyle of humerus was performed with the assistance of the elbow skin fold extension line (study group), and 30 cases were assisted by routine touch of the medial epicondyle of the humerus (control group). There was no significant difference in baseline data such as gender, age, side, cause of injury, Gartland type, Kirschner wire configuration, and time from injury to operation between the two groups ( P>0.05). The closed reduction rate, total operation time, time of medial humeral condyle pin placement, fluoroscopy times during medial pin placement, rate of one-time determination of medial entry point, ulnar nerve injury incidence, and fracture healing time were recorded and compared between the two groups. At the same time, the closed reduction rate of patients with the time from injury to operation ≤24 hours and >24 hours was compared. The elbow function was evaluated by Mayo elbow function score.
RESULTS:
The closed reduction rate of the study group was significantly higher than that of the control group ( P<0.05). Among all patients, the closed reduction rate of patients with the time from injury to operation ≤24 hours [73.3% (22/30)] was significantly higher than that of patients >24 hours [42.9% (12/28)] ( χ 2=5.545, P=0.019). The total operation time, medial needle placement time, and fluoroscopy times in the study group were significantly less than those in the control group, and the one-time determination rate of medial needle entry point in the study group was significantly higher than that in the control group ( P<0.05). There were 4 cases of ulnar nerve injury in the control group, and no ulnar nerve injury in the study group, but there was no significant difference in the incidence of ulnar nerve injury between the two groups ( P>0.05). All patients were followed up 6-12 months (mean, 8 months). There was no bone nonunion in both groups, and the fracture healing time of the study group was significantly shorter than that of the control group ( P<0.05). Volkmann ischemic contracture, heterotopic ossification, myositis ossificans, and premature epiphyseal closure were not observed after operation. No complications such as loosening or fracture of Kirschner wire occurred. At last follow-up, the Mayo elbow joint function score was used to evaluate function, and there was no significant difference between the two groups ( P>0.05).
CONCLUSION
In the treatment of extended supracondylar fractures of the humerus in children, the elbow skin fold extension line can help to quickly locate the medial epicondyle of the humerus, quickly insert Kirschner wire, and reduce the operation time and trauma.
Humans
;
Humeral Fractures/surgery*
;
Bone Wires
;
Male
;
Female
;
Fracture Fixation, Internal/instrumentation*
;
Retrospective Studies
;
Child
;
Elbow Joint/physiopathology*
;
Child, Preschool
;
Treatment Outcome
;
Fracture Healing
;
Ulnar Nerve/injuries*
;
Adolescent
;
Range of Motion, Articular
4.Preliminary study on preparation of decellularized nerve grafts from GGTA1 gene-edited pigs and their immune rejection in xenotransplantation.
Yuli LIU ; Jinjuan ZHAO ; Xiangyu SONG ; Zhibo JIA ; Chaochao LI ; Tieyuan ZHANG ; Xiangling LI ; Shi YAN ; Ruichao HE ; Jiang PENG
Chinese Journal of Reparative and Reconstructive Surgery 2025;39(2):224-229
OBJECTIVE:
To prepare decellularized nerve grafts from alpha-1, 3-galactosyltransferase (GGTA1) gene-edited pigs and explore their biocompatibility for xenotransplantation.
METHODS:
The sciatic nerves from wild-type pigs and GGTA1 gene-edited pigs were obtained and underwent decellularization. The alpha-galactosidase (α-gal) content in the sciatic nerves of GGTA1 gene-edited pigs was detected by using IB4 fluorescence staining and ELISA method to verify the knockout status of the GGTA1 gene, and using human sciatic nerve as a control. HE staining and scanning electron microscopy observation were used to observe the structure of the nerve samples. Immunofluorescence staining and DNA content determination were used to evaluate the degree of decellularization of the nerve samples. Fourteen nude mice were taken, and subcutaneous capsules were prepared on both sides of the spine. Decellularized nerve samples of wild-type pigs ( n=7) and GGTA1 gene-edited pigs ( n=7) were randomly implanted in the subcutaneous capsules. Blood was drawn at 1, 3, 5, and 7 days after implantation to detect neutrophil counting.
RESULTS:
IB4 fluorescence staining and ELISA detection showed that GGTA1 gene was successfully knocked out in the nerves of GGTA1 gene-edited pigs. HE staining showed that the structure of the decellularized nerve from GGTA1 gene-edited pigs was well preserved; the nerve basement membrane tube structure was visible under scanning electron microscopy; no cell nuclei was observed, and the extracellular matrix components was retained in the nerve grafts by immunofluorescence staining; and the DNA content was significantly reduced when compared with the normal nerves ( P<0.05). In vivo experiments showed that the number of neutrophils in the two groups were similar at 1, 3, and 7 days after implantation, with no significant difference ( P>0.05); only at 5 days, the number of neutrophils was significantly lower in the GGTA1 gene-edited pigs than in the wild-type pigs ( P<0.05).
CONCLUSION
The decellularized nerve grafts from GGTA1 gene-edited pigs have well-preserved nerve structure, complete decellularization, retain the natural nerve basement membrane tube structure and components, and low immune response after xenotransplantation through in vitro experiments.
Animals
;
Transplantation, Heterologous
;
Galactosyltransferases/genetics*
;
Sciatic Nerve/immunology*
;
Swine
;
Tissue Engineering/methods*
;
Humans
;
Graft Rejection/prevention & control*
;
Gene Editing
;
Mice
;
Mice, Nude
;
Heterografts/immunology*
;
Animals, Genetically Modified
;
Tissue Scaffolds
;
Decellularized Extracellular Matrix
5.Effectiveness of arthroscopic release assisted with medial small incision in treatment of non-traumatic elbow stiffness.
Lijun LÜ ; Yanyan CHANG ; Baojun ZHOU ; Qiuming GAO ; Jieliang HU ; Liyuan CHEN ; Kongxing WEI ; Fujun GAO ; Wentao LI ; Xin YUAN ; Yibin JIN
Chinese Journal of Reparative and Reconstructive Surgery 2025;39(5):563-568
OBJECTIVE:
To explore the effectiveness of arthroscopic release of elbow joint assisted by medial small incision ulnar nerve release in the treatment of non-traumatic elbow stiffness.
METHODS:
The clinical data of 15 patients with non-traumatic elbow stiffness treated with arthroscopic release of elbow joint assisted by medial small incision ulnar nerve release between April 2019 and September 2023 were retrospectively analyzed. There were 6 males and 9 females with an average age of 46 years ranging from 34 to 56 years. The causes included rheumatoid arthritis in 3 cases, gouty arthritis in 2 cases, loose bodies in 3 cases, and elbow osteoarthritis in 7 cases. There were 4 cases with ulnar neuritis and 3 cases with synovial osteochondromatosis. The duration of elbow stiffness ranged from 6 to 18 months, with an average of 10 months. The operation time and intraoperative blood loss were recorded. The effectiveness was evaluated by visual analogue scale (VAS) score, range of elbow motion (maximum flexion, maximum extension, and total flexion and extension), Mayo score, and Hospital for Special Surgery (HSS) elbow score.
RESULTS:
The operation time was 60-90 minutes, with an average of 65 minutes, and the intraoperative blood loss was 40-100 mL, with an average of 62 mL. All patients were followed up 13-18 months, with an average of 14 months. There was no complication such as vascular and nerve injury, poor wound healing, collateral ligament injury, elbow joint space narrowing, osteophyte proliferation, or loose body formation around the joint. At last follow-up, the elbow range of motion (maximum flexion, maximum extension, and total flexion and extension), VAS score, and Mayo score significantly improved when compared with those before operation ( P<0.05). The HSS elbow score was 85-95, with an average of 92; 12 cases were excellent, 3 cases were good, and the excellent and good rate was 100%.
CONCLUSION
Arthroscopic release of elbow joint assisted by medial small incision ulnar nerve release is an effective way to treat non-traumatic elbow stiffness, which has the advantages of small trauma, short operation time, and good effectiveness. It can carry out early elbow rehabilitation training and significantly improve elbow function.
Humans
;
Male
;
Female
;
Arthroscopy/methods*
;
Adult
;
Middle Aged
;
Elbow Joint/physiopathology*
;
Retrospective Studies
;
Range of Motion, Articular
;
Treatment Outcome
;
Ulnar Nerve/surgery*
;
Operative Time
6.Application of index finger proximal dorsal island flap supplied by nutrient vessels of superficial branch of radial nerve for thumb skin and soft tissue defect.
Huanyou YANG ; Huiwen ZHANG ; Wenqian BU ; Wei WANG ; Jian ZHANG ; Bin WANG
Chinese Journal of Reparative and Reconstructive Surgery 2025;39(7):869-872
OBJECTIVE:
To explore the method and effectiveness of index finger proximal dorsal island flap supplied by the nutrient vessels of superficial branch of radial nerve for treatment of thumb skin and soft tissue defect.
METHODS:
Between August 2019 and December 2024, 12 patients with thumb skin and soft tissue defects caused by trauma accompanied by variation of the first dorsal metacarpal artery were treated. There were 8 males and 4 females, aged 19-55 years, with an average age of 32 years. The wound area ranged from 2.2 cm×2.0 cm to 5.5 cm×3.5 cm. The time from injury to operation ranged from 1.5 to 6.0 hours, with an average of 4.5 hours. After thorough debridement, the wound was repaired with a index finger proximal dorsal island flap supplied by the nutrient vessels of the superficial branch of the radial nerve. The flap area ranged from 2.4 cm×2.2 cm to 6.0 cm×4.0 cm. The donor site was repaired with free skin grafting. Regular follow-up was conducted postoperatively to observe the appearance, texture, sensory recovery of the flap, and the condition of the donor site.
RESULTS:
The operation time ranged from 30 to 72 minutes, with an average of 47 minutes; intraoperative blood loss ranged from 30 to 70 mL, with an average of 46 mL. After operation, partial necrosis occurred at the skin edge of the radial incision on the dorsum of the hand in 1 case, which healed after dressing changes; all other flaps survived uneventfully, with primary wound healing. The skin grafts at the donor sites all survived. All 12 patients were followed up 5-36 months, with an average of 14 months. The appearance and texture of the flaps were good. At last follow-up, the two-point discrimination of the flaps ranged from 4 to 9 mm, with an average of 5.2 mm. According to the functional evaluation criteria for upper limb issued by the Hand Surgery Society of Chinese Medical Association, the results were excellent in 11 cases and good in 1 case. No scar contracture, pain, or joint movement limitation was observed at the donor sites.
CONCLUSION
For patients with skin and soft tissue defects of the thumb accompanied by variation of the first dorsal metacarpal artery, the index finger proximal dorsal island flap supplied by the nutrient vessels of the superficial branch of the radial nerve can be selected. This method has advantages such as shorter operation time, less intraoperative bleeding, and good postoperative appearance and sensation of the flap.
Humans
;
Male
;
Adult
;
Female
;
Thumb/surgery*
;
Soft Tissue Injuries/surgery*
;
Radial Nerve/surgery*
;
Middle Aged
;
Surgical Flaps/innervation*
;
Plastic Surgery Procedures/methods*
;
Skin Transplantation/methods*
;
Young Adult
;
Treatment Outcome
;
Fingers/surgery*
;
Skin/injuries*
7.Endoscopic-assisted median nerve decompression combined with one-stage tendon transfer for reconstruction of thumb abduction in treatment of severe carpal tunnel syndrome.
Jiaxing SUI ; Yong YANG ; Zhenzhong WANG ; Xingjian HUANG ; Xuanyu JIANG ; Lihui ZHANG ; Haiyang LI
Chinese Journal of Reparative and Reconstructive Surgery 2025;39(12):1510-1515
OBJECTIVE:
To investigate the effectiveness of endoscopic-assisted median nerve decompression with one-stage extensor indicis proprius (EIP) tendon transfer for reconstruction of thumb abduction in patients with severe carpal tunnel syndrome (CTS).
METHODS:
The clinical data of 12 patients with severe CTS who met the selection criteria between December 2019 and December 2024 were retrospectively analyzed. There were 2 males and 10 females with an average age of 55.4 years ranging from 35 to 67 years. The symptom duration of CTS was 12-120 months (mean, 48.7 months) and the thenar muscle atrophy duration was 6-48 months (mean, 13.4 months). The median nerve was released with the help of endoscope, and the EIP tendon was transferred to reconstruct the abduction function of the thumb. The operation time and complications were recorded. Two-point discrimination, palmar abduction angle of the thumb, radial abduction angle of the thumb, and pinch force of the thumb were measured and compared before operation and at last follow-up, and the effectiveness was evaluated by Kapandji score and Disabilities of the Arm, Shoulder and Hand (DASH) score. The satisfaction of the operation was evaluated at last follow-up.
RESULTS:
All surgeries were successfully completed with a mean operation time of 54 minutes (range, 45-68 minutes). All patients were followed up 6-50 months, with an average of 15.3 months. There was no complications such as wound infection, scar pain of wrist, or tendon rupture of transposition, and there were 3 cases of mild limitation of finger extension in the donor site of index finger. At last follow-up, two-point discrimination, palmar abduction angle of the thumb, radial abduction angle of the thumb, Kapandji score, and DASH score were significantly better than those before operation ( P<0.05), but there was no significant difference in thumb pinch force between pre- and post-operation ( P>0.05). The evaluation of surgical satisfaction showed that 7 cases were very satisfied and 5 cases were satisfied.
CONCLUSION
The combination of endoscopic-assisted median nerve decompression and one-stage EIP tendon transfer effectively improves hand function and quality of life in patients with severe CTS by restoring thumb abduction and alleviating neurological symptoms.
Humans
;
Tendon Transfer/methods*
;
Male
;
Middle Aged
;
Carpal Tunnel Syndrome/physiopathology*
;
Female
;
Decompression, Surgical/methods*
;
Aged
;
Adult
;
Thumb/physiopathology*
;
Endoscopy/methods*
;
Retrospective Studies
;
Median Nerve/surgery*
;
Treatment Outcome
;
Plastic Surgery Procedures/methods*
8.Effectiveness analysis of tibial nerve transection with epineurial suture and division of common plantar digital nerve branches in treatment of congenital macrodactyly in children.
Dongmei LI ; Guanglei TIAN ; Jianfeng LI ; Min ZHAO ; Liang ZHAO ; Jingda LIU ; Hailei LI
Chinese Journal of Reparative and Reconstructive Surgery 2025;39(12):1562-1567
OBJECTIVE:
To evaluate the effectiveness of tibial nerve transection with epineurial suture and division of the common plantar digital nerve branches in the treatment of congenital macrodactyly in children.
METHODS:
A retrospective analysis was conducted on clinical data from 9 children with congenital macrodactyly who met the selection criteria and were admitted between January 2018 and December 2024. The cohort included 4 boys and 5 girls, aged 1-6 years (median, 3 years). Syndactyly of the second and third toes was present in 2 patients. Hypertrophy distribution was as follows: 1 case of single-ray involvement, 4 of double-ray, 1 of triple-ray, 1 of quadruple-ray, and 2 of quintuple-ray. Preoperatively, 7 cases exhibited limitations in both active and passive flexion and extension of the affected toes; in 2 cases, active movement was restricted while passive motion remained intact. All 9 children were unable to wear standard-sized footwear for the unaffected foot. Six presented with a limp, and 3 had difficulty walking. All 9 cases were moderate to severe progressive macrodactyly, and the growth rate of the affected foot was significantly faster than that of the healthy side. Six cases had undergone prior surgical interventions at other institutions, but disease progression continued postoperatively. All 9 patients underwent tibial nerve transection with epineurial suture and selective division of the common plantar digital nerve branches. At last follow-up, the foot growth rate was calculated (compared with that immediately after operation), and the changes of plantar pain sensation in the affected foot were detected before operation, immediately after operation, and at last follow-up, and the surgical efficacy was evaluated based on improvements in shoe fit and gait function.
RESULTS:
All 9 children were followed up 6-36 months, with an average of 18 months. All the incisions healed by first intention, and no infection or plantar ulceration occurred. At last follow-up, the growth rate of the affected foot was 0.10 (0.04, 0.14) cm/month, which was significantly slower than that of the healthy foot [0.14 (0.08, 0.18) cm/month] ( Z=3.951, P<0.001). Preoperatively, plantar pain sensation was absent in all cases; it was restored immediately after operation. At last follow-up, 6 patients had absent pain sensation, 2 had partial preservation (involving certain toes and central plantar regions), and 1 patient (with 3-year follow-up) exhibited regained sensation in multiple plantar areas. Gait improved in most cases, in which 8 children achieved normal ambulation, while 1 continued to limp due to leg-length discrepancy. Surgical efficacy were rated as excellent in 1 case, good in 7, and fair in 1.
CONCLUSION
Tibial nerve transection with epineurial suture combined with selective division of the common plantar digital nerve branches effectively reduces the growth rate of congenital macrodactyly in children, has minimal impact on plantar sensory function, and does not result in plantar ulcers or impaired ambulation.
Humans
;
Male
;
Female
;
Child, Preschool
;
Child
;
Retrospective Studies
;
Infant
;
Tibial Nerve/surgery*
;
Toes/surgery*
;
Treatment Outcome
;
Suture Techniques
;
Fingers/surgery*
;
Foot/innervation*
;
Limb Deformities, Congenital
9.Clinical application of nerve block in early analgesia after anterior cruciate ligament reconstruction.
Bing-Gen LIU ; Si-Feng CHEN ; Cui ZHANG ; Ming LEI ; Guan ZHANG
China Journal of Orthopaedics and Traumatology 2025;38(3):287-292
OBJECTIVE:
To explore clinical effective and safety of subarachnoid block (SA), adductor canal block (ACB), and femoral nerve block (FNB) for early analgesia in anterior cruciate ligament (ACL) reconstruction.
METHODS:
From September 2022 to October 2023, 90 patients with ACL rupture who received unilateral knee arthroscopic ACL reconstruction were selected and divided into ACB group, FNB group and SA group according to different anesthesia methods, with 30 patients in each group. There were 12 males and 18 females in ACB group, aged from 18 to 60 years old with an average of (33.3±13.8) years old;14 patients with gradeⅠand 16 patients with gradeⅡaccording to American Society of Aneshesiologists (ASA);13 patients on the left side and 17 patients on the right side. There were 15 males and 15 females in FNB group, aged from 18 to 60 years old with an average of (33.5±12.9) years old;15 patients with gradeⅠand 15 patients with gradeⅡ;16 patients on the left side and 14 patients on the right side. There were 16 males and 14 females in SA group, aged from 18 to 60 years old with an average of (31.0±12.6) years old;18 patients with grade I and 12 patients with gradeⅡ;17 patients on the left side and 13 patients on the right side. In ACB and FNB groups, the nerve block of ACB and FNB were performed under ultrasound guidance before SA anesthesia with 15 ml of 0.3% ropivacaine. Visual analogue scale (VAS) and quadriceps muscle strength at rest and passive movement were recorded and compared among 3 groups at 4, 8, 12, 16, 24 and 48 h after operation, as well as the dosage of tramadol injection analgesics, incidence of nausea and vomiting, nerve block time and other complications within 48 h after operation were compared.
RESULTS:
All patients were followed up for 11 to 20 (15.8±2.4) months. VAS at 4, 8, 12, 16, 24 and 48 h after operation of SA group was significantly higher than that of ACB and FNB groups, with statistical significance (P<0.05). There were no significant difference in VAS of rest and passive movement at 4, 8, 12, 16, 24 and 48 h after operation between ACB group and FNB group(P>0.05). At 4, 8, 12 and 16 h after operation, the quadriceps muscle strength in SA and ACB groups was higher than that in FNB group, with statistical significance (P<0.05);but there was no statistical significance in quadriceps muscle strength among three groups at 24 and 48 h after operation(P>0.05). One patient occurred nausea and vomiting in ACB group, 2 patients in FNB group and 5 patients in SA group, and no significant difference among three groups (χ2=0.352, P=0.171). The dosage of tramadol in SA group was (300.00±136.50) mg, which was higher than that in FNB group (168.33±73.70) mg and ACB(163.33±70.70) mg, and the difference was statistically significant (P<0.05). There was no significant difference in nerve block time between ACB group and FNB group (t=1.964, P=0.054). There was no puncture site bleeding, local anesthesia drug poisoning and hematoma formation among three groups.
CONCLUSION
Both FNB and ACB could provide good early analgesia after ACL reconstruction, but ACB group has little effect on quadriceps muscle strength. Patients could have early postoperative functional training without pain, which is more beneficial to the recovery of knee joint function, and could reduce the use of analgesic drugs, without serious complications, which is safe and reliable method.
Humans
;
Male
;
Female
;
Nerve Block/methods*
;
Adult
;
Anterior Cruciate Ligament Reconstruction
;
Adolescent
;
Middle Aged
;
Young Adult
;
Analgesia/methods*
;
Pain, Postoperative/drug therapy*
;
Femoral Nerve
10.Effects of different concentrations of ropivacaine in femoral nerve block on early motor function following total knee arthroplasty.
Yong-Cheng CHEN ; Qiang ZAN ; Yu-Meng FU ; Shi-Hang CAO ; Li-Qiang ZHI
China Journal of Orthopaedics and Traumatology 2025;38(7):693-697
OBJECTIVE:
To compare the effects of different concentrations of ropivacaine femoral nerve block on postoperative pain and early exercise fllowing total knee arthroplasty(TKA).
METHODS:
A total of 90 patients who underwent primary TKA between September 2022 and February 2023 were consecutively enrolled in this study. The cohort consisted of 34 males and 56 females, with a mean age of (66.66±7.03) years old. According to different concentrations of ropivacaine, patients were divided into 0.1% group, 0.2% group and 0.4% group, with 30 patients in each group. The age, gender, body mass index(BMI), American Society of Aneshesiologists(ASA) grade, operation time, anesthesia time, tourniquet using time, Post Anesthesia care unit(PACU) stay duration, ambulation time, first reaching to Bromage 0 grade time, visual analogue scale(VAS), hospitalization period and postoperative adverse reactions were compared among the three groups.
RESULTS:
All 90 patients were followed up for an average of (31.56±5.62) days, and no postoperative adverse reactions occurred. There were no significant differences among the three groups in terms of age, gender, BMI, ASA classification, operation time, anesthesia time, tourniquet application time, PACU stay duration, and hospitalization period (P>0.05). Significant differences were observed in VAS scores at 1, 2, 4, 6, and 12 hours post-operation among the three groups (P<0.05). Additionally, significant variations were noted in ambulation time and the first reaching to Bromage level 0 time among the three groups (P<0.05). In terms of postoperative pain, the VAS of the 0.1% group at 1, 2, 4, 6, and 12 hours after surgery(1.93±0.52), (2.57±0.77), (3.10±0.71), (3.10±0.71), (3.07±0.45) points were higher than those of the 0.4% group (1.57±0.50), (2.10±0.55), (2.23±0.57), (2.47±0.73), (2.50±0.57) points, and the differences were statistically significant (P<0.05);the VAS of the 0.1% group at 4, 6, and 12 hours after surgery were higher than those of the 0.2% group (2.43±0.57), (2.53±0.57), (2.63±0.56) points, and the differences were statistically significant (P<0.05);there was no statistically significant difference in VAS between the 0.2% group and the 0.4% group (P>0.05). In terms of early postoperative mobility, the time to ambulation time (8.30±2.76) h and the time to achieve the first Bromage grade 0 (6.13±2.18) h were significantly prolonged in the 0.4% group compared to both the 0.1% group (6.93±1.76) h, (4.17±1.18) h and the 0.2% group (6.53±1.59) h, (4.87±1.53) h. No statistically significant differences were observed between the 0.1% and 0.2% groups (P>0.05).
CONCLUSION
0.2% ropivacaine femoral nerve block can effectively reduce postoperative pain after TKA and can perform early exercise earlier.
Humans
;
Male
;
Female
;
Ropivacaine/administration & dosage*
;
Arthroplasty, Replacement, Knee/adverse effects*
;
Aged
;
Nerve Block/methods*
;
Femoral Nerve/drug effects*
;
Middle Aged
;
Pain, Postoperative/drug therapy*
;
Anesthetics, Local/administration & dosage*
;
Amides

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