摘要目的:对比不同阻滞方式在老年股骨颈骨折患者全髋关节置换术中的应用效果。方法:抽取2018年1月至2021年1月在义马煤业集团股份有限公司总医院接受全髋关节置换术的老年股骨颈骨折患者180例，采用随机数字表法分为对照组和观察组，每组90例。对照组采用髂筋膜阻滞，观察组采用腰方肌阻滞。比较两组术后6 h(T0)、8 h(T1)、12 h(T2)、24 h(T3)时的静息、被动运动疼痛视觉模拟评分法(VAS)评分，统计两组临床指标(阻滞操作完成时间、静脉自控泵中舒芬太尼用量)及麻醉相关并发症发生情况。结果:单独效应分析结果显示，两组T0时静息、被动运动VAS评分比较差异未见统计学意义( P>0.05)；T1、T2、T3时，观察组与对照组静息、被动运动VAS评分比较差异均有统计学意义( P均<0.05)；两组T0时静息、被动运动VAS评分与T1、T2、T3时比较差异有统计学意义( P<0.05)。两组阻滞操作完成时间比较差异未见统计学意义( P>0.05)。观察组静脉自控泵中舒芬太尼用量[(53.82±3.03)μg]少于对照组[(56.25±3.52)μg]， P<0.05；麻醉相关并发症发生率(4.44%，4/90)低于对照组(11.11%，10/90)， P<0.05。 结论:与髂筋膜阻滞相比，腰方肌阻滞可减轻老年股骨颈骨折患者全髋关节置换术后的疼痛程度，减少术后静脉镇痛药物使用量，且安全性高。

abstractsObjective:To compare the effect of different block methods in total hip arthroplasty for elderly patients with femoral neck fractures.Methods:A total of 180 elderly patients with femoral neck fractures who underwent total hip arthroplasty in General Hospital of Yima Coal Industry Group Co., Ltd. from January 2018 to January 2021 were selected and divided into control group and observation group by random number table method, with 90 cases in each group. The control group was blocked by iliac fascia, and the observation group was blocked by psoas quadratus muscle. The visual analogue scale (VAS) scores of resting and passive motor pain at 6 h (T0), 8 h (T1), 12 h (T2) and 24 h (T3) were compared between the two groups. And the clinical indexes (block completion time and sufentanil dosage in the intra venous automatic control pump) and complications of the two groups were counted.Results:Results of simple effect analysis showed that there was no significant difference in the VAS scores of resting and passive movement between the two groups at T0 ( P>0.05); there were significant differences in the VAS scores of resting and passive movement at T1, T2 and T3 between the observation group and the control group (all P<0.05); the resting and passive movement VAS score at T0 in the observation group and the control group were significantly different from those at T1, T2 and T3 ( P<0.05). There was no significant difference in the completion time of blocking operation between the two groups ( P>0.05). The dosage of sufentanil in the intravenous automatic control pump in the observation group was (53.82±3.03)μg, less than the (56.25±3.52)μg in the control group ( P<0.05). The incidence of anesthesia related complications in the observation group (4.44%, 4/90) was lower than that in the control group (11.11%, 10/90), P<0.05. Conclusions:Compared with iliac fascia block, psoas quadratus block can reduce the degree of pain after total joint replacement of femoral neck fractures in the elderly, reduce the use of postoperative intravenous analgesics, and has high safety.