股骨支闭孔神经干（FRONT）阻滞在髓内钉手术中的应用 (FRONT block)

假比较器：Control group

Sham Control: Patients underwent an identical ultrasound-guided needle insertion procedure at the same anatomical sites (iliopsoas plane and subpectineal compartment) with injection of an equivalent volume of placebo drug in the form of normal salin. All patients, including the sham group, received the same standardized multimodal systemic analgesic regimen (paracetamol 1g/6h and ketorolac 30 mg /8h routinely plus nalbuphine 6 mg IV bolus as rescue analgesia when needed for NRS ≥ 4)

程序：Sham block

Sham Control: Patients underwent an identical ultrasound-guided needle insertion procedure at the same anatomical sites and technique of FRONT block (iliopsoas plane and subpectineal compartment) with injection of an equivalent volume of placebo drug in the form of normal saline.

实验性的：FRONT Block

FRONT Block: Patients received an ultrasound-guided femoral rami and obturator nerve trunk (FRONT) block, performed in the operating room prior to spinal anesthesia with the patient supine. Using an in-plane technique with a 22-gauge echogenic needle through a single entry point, 20 mL of 0.125% plain levobupivacaine was deposited in the iliopsoas plane and 20 mL in the subpectineal compartment. Electrical nerve stimulation (0.4 mA, 0.1 ms pulse duration) was used to confirm needle placement and exclude direct femoral motor nerve involvement prior to injection. Sensory block was checked by pinprick before proceeding to spinal anesthesia as routine clinical practice; these findings were not systematically recorded. All patients, including the FRONT group, received the same standardized multimodal systemic analgesic regimen (paracetamol 1g/6h and ketorolac 30 mg /8h routinely plus nalbuphine 6 mg IV bolus as rescue analgesia when needed for NRS ≥ 4)

程序：股骨闭孔神经干（前侧）阻滞

将在腹股沟下水平进行超声引导下的FRONT阻滞，目标是腰大肌平面。 使用相同的针头进路，还将进入耻骨下间隙。 我们将使用超声和电神经刺激引导（0.4 mA，0.1 ms，不引发运动反应）以避免直接涉及股神经。 将总共给予40 mL（腰大肌平面20 mL，耻骨下间隙20 mL）0.125%的纯左布比卡因。

Time to first postoperative analgesic request

Description: Time in hours when the first patient request for rescue analgesia (IV nalbuphine 6 mg iv bolus)

并发症

任何并发症，无论是外科手术相关还是副作用，都将被记录（呕吐、过敏、尿潴留等）

Numeric Rating Scale (NRS)

Score from 0 = no pain at all to 10= worst pain imaginable, both at rest and movement

Manual Muscle Testing (MRC scale)

Quadriceps strength graded manually against examiner resistance using the Medical Research Council (MRC) 0-5 scale, performed by the blinded outcome assessor.

Straight Leg Raise (SLR) test

Description: Ability to actively raise the extended leg off the bed, assessed as a functional indicator of quadriceps/hip flexor motor recovery, performed by the blinded outcome assessor.

Opioid consumption

total opioid consumption will be recorded postoperatively