桡神经浅支与骨膜阻滞及臂丛神经阻滞在桡骨远端骨折无痛手法复位中的麻醉效果比较  

Comparison of the anesthetic effects of superficial radial nerve with periosteum block and brachial plexus block on painless reduction of distal radius fracture

作　　者：刘洋[1] 王生[2] 韩庆波[1] 王振华[1] LIU Yang;WANG Sheng;HAN Qingbo(Department of Anesthesia,Kailuan General Hospital,Hebei,Tangshan 063000,China;不详)

机构地区：[1]开滦总医院麻醉科,河北省唐山市063000 [2]河北省唐山工人医院皮肤科

出　　处：《河北医药》2021年第7期1073-1075,共3页Hebei Medical Journal

摘　　要：目的研究对比桡神经浅支与骨膜阻滞及臂丛神经阻滞对桡骨远端骨折无痛手法复位的麻醉效果。方法82例桡骨远端骨折无痛手法复位患者按照随机数字表法分成研究组和对照组,每组41例。对照组实施臂丛神经阻滞,研究组则实施桡神经浅支与骨膜阻滞。比较2组麻醉时间、麻醉起效时间以及麻醉后疼痛情况,一次性复位成功率、骨折愈合时间以及不良反应发生率。此外,比较桡骨远端骨折无痛手法复位失败与成功患者的各项基线资料,并作多因素Logistic回归分析。结果研究组麻醉时间短于对照组(P<0.05);而2组麻醉起效时间、麻醉后VAS评分比较,差异无统计学意义(P>0.05)。2组一次性复位成功率、骨折愈合时间以及不良反应发生率比较,差异无统计学意义(P>0.05)。复位失败患者年龄≥60岁、合并骨质疏松以及骨折分型为C型人数占比均高于复位成功患者(P<0.05)。经多因素Logistic回归分析可得:年龄≥60岁以及骨折分型为C型均是桡骨远端骨折无痛手法复位失败的独立危险因素(OR>1,P<0.05)。结论桡神经浅支与骨膜阻滞应用于桡骨远端骨折无痛手法复位中的麻醉时间短于臂丛神经阻滞,但二者总体应用效果相当。此外,随着年龄的增长以及骨折分型为C型,桡骨远端骨折无痛手法复位失败的发生风险越高。Objective To compare the anesthetic effects of superficial radial nerve with periosteum block and brachial plexus block on painless reduction of distal radius fracture.Methods Eighty-two patients with distal radius fracture who were treated in our hospital from January 2017 to December 2019 were randomly divided into research group(n=41)and control group(n=41).The patients in control group were treated by brachial plexus block,howevr,the patients in research group were treated by superficial radial nerve and periosteal block.The anaesthesia duration,anaesthesia onset time,the pain after anaesthesia,fracture healing,the success rate of diposable reduction and the incidence of adverse reactions were compared between the two groups.Moreover,baseline data of patients with distal radius fracture who had failed or succeeded in painless reduction were observed and compared between the two groups,moreover,the multivariate Logistic regression analysis was performed.Results The anesthesia duration in research group was significantly shorter than that in control group(P<0.05).There were no significant differences in the onset time of anesthesia,VAS scores,the one-time reduction success rate,the time of fracture healing and the incidence of adverse reactions between the two groups(P>0.05).The proportion of patients with failling to reduction,60 years or older,combined with osteoporosis and fracture type C was significantly higher than that of patients with successful reposition(P<0.05).Logistic regression analysis showed that patient’s age≥60 years and fracture type C were the independent risk factors for the failure of painless reduction for distal radius fracture(P<0.05).Conclusion The anesthesia time of superficial radial nerve and periosteum block in painless reduction of distal radial fracture is shorter than that of brachial plexus block,but the overall effects of both are similar.The risk of failure of painless reduction increases with age and type C fracture.

关 键 词：桡骨远端骨折 无痛手法复位 桡神经浅支 骨膜阻滞 臂丛神经阻滞 

分 类 号：R971.2[医药卫生—药品]