Wide-awake技术在掌骨骨折手术中的应用  

The application of the wide-awake technique in metacarpal fracture surgery

作　　者：赵俊 杨光[2] 宫可同[3] 徐建华[3] ZHAO Jun;YANG Guang;GONG Ketong(Graduate school of Tian Jin University of Traditional Chinese Medicine,Tianjin,300193,China)

机构地区：[1]天津中医药大学研究生院,天津300193 [2]天津中医药大学第一附属医院骨伤科,天津300381 [3]天津医院手显微外科,天津300210

出　　处：《实用手外科杂志》2019年第4期390-391,394,共3页Journal of Practical Hand Surgery

摘　　要：目的介绍完全清醒(Wide-awake)的无血无痛无止血带技术在掌骨骨折手术中的应用效果。方法2017年10月-2018年12月,应用Wide-awake技术对57例患者行掌骨骨折内固定术和内固定取出术,其中骨折内固定术46例(克氏针26例,空心钉11例,钢板9例),内固定取出术11例。术前的注射疼痛、术中和术后的疼痛均使用视觉模拟评分法(VAS)评估,术中评估术区出血情况,术后观察麻醉持续时间及并发症、术区皮肤的血供。结果在不使用止血带的情况下,Wide-awake技术可达到较好的止血效果,并且术前注射时仅有第一针的疼痛(VAS评分为2~4分),术中软组织操作无疼痛(VAS评分为0分),骨操作仅有轻微的疼痛(VAS评分为1~2分)。术后麻醉效果可持续2~3 h,均未出现术区皮肤的缺血坏死和麻醉并发症。结论 Wide-awake技术安全有效,无需止血带,止血效果良好,术区视野清晰,操作简单,性价比高,可广泛应用于急、门诊手术。Objective To introduce the application of wide-awake bloodless, painless and non-tourniquet technique in the treatment of metacarpal fractures. Methods From October 2017 to December 2018, 57 patients underwent internal fixation and removal of internal fixation for the treatment of 57 patients with metacarpal fracture. Among them, 46 patients underwent internal fixation(26 patients with Kirschner wire and 11 patients with cannulated nails, 9 cases of steel plate), 11 cases of removal of internal fixation.Preoperative pain, intraoperative and postoperative pain were assessed using visual analogue scale(VAS),intraoperative hemorrhage was assessed during surgery, postoperative anesthesia duration and complications, and blood supply to the skin of the site were observed. Results The wide-awake technique achieved better hemostasis without the use of a tourniquet, and only the first needle was painful before the injection(VAS score 2 to 4), and the intraoperative soft tissue operation was painless(VAS score 0), bone surgery had only mild pain(VAS score 1 to 2). The postoperative anesthetic effect lasted for 2-3 hours, and there was no ischemic necrosis and anesthesia complications in the skin of the operation area. Conclusion The wide-awake technique is safe and effective, does not require a tourniquet, has a good hemostatic effect, clear vision in the operation area, simple operation and cost-effective performance. It can be widely used in emergency and outpatient operation.

关 键 词：Wide-awake 掌骨骨折 手外科手术 

分 类 号：R658.2[医药卫生—外科学]