“鸡尾酒”封闭在GartlandⅢ型儿童肱骨髁上骨折术后的早期镇痛效果  

Cocktail local analgesia in postoperative pain management for pediatric supracondylar fracture of humerus with Gartland type Ⅲ

作　　者：陈灿旭 庄婷婷 连松勇 陈毕能 林友聪 陈伟龙 吕辉照 Chen Canxu;Zhuang Tingting;Lian Songyong;Chen Bineng;Lin Youcong;Chen Weilong;Lv Huizhao(Department of Rehabilitation,The 910th Hospital of Chinese PLA,Quanzhou Fujian,362000;Department of Pediatric Orthopedics,The 910th Hospital of Chinese PLA,Quanzhou Fujian,362000,China)

机构地区：[1]中国人民解放军联勤保障部队第910医院康复医学科,福建泉州362000 [2]中国人民解放军联勤保障部队第910医院小儿骨科,福建泉州362000

出　　处：《生物骨科材料与临床研究》2023年第1期56-61,共6页Orthopaedic Biomechanics Materials and Clinical Study

摘　　要：目的 比较“鸡尾酒”封闭与臂丛神经阻滞在GartlandⅢ型儿童肱骨髁上骨折术后镇痛的临床效果。方法2018年1月至2020年2月,58例儿童肱骨髁上骨折患者纳入本研究。其中,男34例,女24例;年龄2~10岁,平均(6.53±2.44)岁。根据抽签法随机分组,封闭组(39例)采用骨折端血肿内“鸡尾酒”封闭镇痛,神经阻滞组(19例)采用臂丛神经阻滞镇痛。记录术后WB-FACES疼痛评分、肿胀分级及麻醉中毒反应情况,在随访过程中记录骨折临床愈合时间及Mayo肘关节功能评分、肘关节屈-伸ROM、前臂旋前-旋后ROM。结果 所有患者均获得随访,随访时间12~37个月,平均(17.32±4.02)个月。术后1 d和7 d时两组间的WB-FACES疼痛评分、肿胀分级比较,差异无统计学意义(P>0.05);但术后2 d和3 d,封闭组的WB-FACES疼痛评分和肿胀分级显著低于神经阻滞组,差异有统计学意义(P<0.05)。两组间麻醉中毒反应分级比较,差异无统计学意义(P>0.05)。封闭组骨折愈合时间为(5.46±1.41)周,神经阻滞组则为(5.11±1.15)周,两组间比较差异无统计学意义(t=0.955,P=0.343)。术后3个月和末次随访时,两组患者Mayo肘关节评分、肘关节屈-伸ROM和前臂旋前-旋后ROM比较,差异无统计学意义(P>0.05)。结论 儿童GartlandⅢ型肱骨髁上骨折采用“鸡尾酒”封闭在术后早期疼痛控制中优于臂丛神经阻滞,而且操作简单,安全性与神经阻滞类似。Objective To compare the effect of cocktail local analgesia and brachial plexus block in postoperative pain management for pediatric supracondylar fracture of humerus with Gartland typeⅢ.Methods Between January 2018 and February 2020,58 children with supracondylar fracture of humerus with Gartland typeⅢwere included.There were 34males and 24 females,the mean age was (6.53±2.44) years(range 2 to 10 years).All patients were randomly divided into two groups:39 cases in cocktail group used cocktail local analgesia,and 19 cases in nerve blocking group uesd brachial plexus block.WB-FACES pain score,swelling grade,anaesthetic toxic reaction were recorded,and at following up time of bone healing,Mayo score,ROM of elbow flexion and extension,and ROM of arm pronation and supination were recorded.Results All children were followed up for (17.32±4.02) months(ranged from 12 to 37 months).WB-FACES pain score and swelling grade in cocktail group at 1stday and 7thday were similar to nerve blocking group (P>0.05),but lower than nerve blocking group at 2ndday and 3rdday (P<0.05).There was no significant difference between the two groups regarding to anaesthetic toxic reaction (P>0.05).The time of bone healing in cocktail group[(5.46±1.41) weeks]was similar to nerve blocking group[(5.11±1.15) weeks](t=0.955,P=0.343).Regarding to Mayo score,ROM of elbow flexion and extension,and ROM of arm pronation and supinatio,there was no significant difference between two groups at 3rdmonth and last follow-up (P>0.05).Conclusion The effect of early pain management with cocktail local analgesia for Gartland typeⅢpediatric supracondylar fracture of humerus is superior to brachial plexus block.It is simple to operate,and has the same safety as brachial plexus block.

关 键 词：肱骨髁上骨折 儿童 “鸡尾酒”镇痛 臂丛神经阻滞 罗哌卡因 

分 类 号：R683.41[医药卫生—骨科学]