WALANT技术在掌骨骨折克氏针内固定中的应用  

Application of WALANT technique in internal fixation of metacarpal fracture with Kirshner wire

作　　者：张杰 李津[2] 阚世廉[2] 李瑞华[2] 高燕新[2] ZHANG Jie;LI Jin;KAN Shilian(Department of Orthopedics and Traumatology,Ninghe District Hospital of Traditional Chinese Medicine,Tianjin,301500,China)

机构地区：[1]天津市宁河区中医医院骨伤科,天津301500 [2]天津医院手显微外科,天津300211

出　　处：《实用手外科杂志》2020年第3期314-316,共3页Journal of Practical Hand Surgery

摘　　要：目的介绍完全清醒的无血无止血带局麻技术(wide-awake local anesthesia no tourniquet,WALANT)在掌骨骨折切开复位克氏针内固定术中的应用。方法2018年5月-2019年1月应用WALANT技术对11例掌骨骨折患者进行切开复位克氏针内固定,术后高分子石膏托外固定,即刻开始主动功能训练,3~6周拔出克氏针。术前的注射疼痛、术中和术后的疼痛均使用数字评分法(VAS)评估;术中评估术野出血情况;术后观察麻醉不良反应和手术切口周围皮肤血供;术后随访记录手指总主动活动度(total active motion,TAM)及上肢功能评定表(disability of the arm,shoulder and hand questionnaire,DASH量表)评价关节活动度,末次随访使用Jamar测力计测量双手握力。结果VAS评分术前注射时仅第一针轻度疼痛,评分1.8分(范围1~3分),术中无疼痛,评分0分。患者均未出现头痛、头晕、恶心、呕吐等麻醉不良反应,未出现甲床苍白、充盈时间延长、温度降低等患指远端供血障碍。术中出血少,平均约5 mL。临床骨折愈合时间4.36周(4~6周)。DASH评分均值1.5分(0~5分);TAM均值244.5°(220°~260°);Jamar握力47.72 kg(33~52 kg)。结论WALANT技术在掌骨骨折切开复位克氏针内固定中的应用安全,无需止血带,可起到良好的止血作用,手术无疼痛,操作简单,有利于开展门诊手术。Objective To introduce the application of completely awake bloodless and tourniquet local anesthesia(WALANT)in open reduction and internal fixation of metacarpal fractures with kirschner wire.Methods From May 2018 to January 2019,11 patients were treated with open reduction and kirschner wire internal fixation for metacarpal fracture using WALANT technology.External fixation with polymer plaster support,active functional exercise immediately after surgery,and extraction of Kirshner’s needle in3-6 weeks.Preoperative,intraoperative and postoperative infection pain were evaluated by(VAS).Intraoperative bleeding was evaluated in operative field,postoperative observation of operative incision of anesthetic adverse reactions and the surrounding skin blood supply,postoperative follow-up record fingers total active motion(total active motion,TAM)and upper limbs function evaluation form(disability of the arm,shoulder and hand questionnaire,DASH scale)evaluation of motion,at the last follow-up,the Jamar dynamometer was used to measure grip strength.Results VAS score:only the first injection had mild pain 1.8(1~3)before the operation,but no pain during the operation,and the score was0.No adverse anesthesia reactions such as headache,dizziness,nausea and vomiting occurred in the patients,and no paleness in the nail bed,prolonged filling time and decreased temperature were found in the patients.Intraoperative bleeding was low,averaged about 5 ml.Clinical fracture healing time was 4.36 weeks(range 4~6 weeks).The mean of DASH score was 1.5(range 0~5);TAM means 244.5°(range 220°~260°),jamar grip strength 47.72 kg(range 33~52 kg).Conclusion The application of WALANT technology in the open reduction of metacarpal fracture kirschner wire internal fixation is safe,without tourniquet,can play a good hemostatic effect,the operation is painless,the operation is simple,is conducive to the development of outpatient surgery.

关 键 词：WALANT技术 麻醉 掌骨骨折 克氏针 内固定 

分 类 号：R687.3[医药卫生—骨科学]