完全清醒技术在近指间关节松解术中的临床应用  

Clinical application of wide-awake technique in proximal interphalangeal joint arthrolysis

作　　者：刘宇舟 陆征峰 杨浩钰 刘剑 魏苏明 Liu Yuzhou;Lu Zhengfeng;Yang Haoyu;Liu Jian;Wei Suming(Department of Hand Surgery,Wuxi No.9 Hospital,Wuxi 214062,China)

机构地区：[1]无锡市第九人民医院手外科,无锡214062

出　　处：《中华手外科杂志》2022年第6期506-510,共5页Chinese Journal of Hand Surgery

摘　　要：目的介绍完全清醒(Wide-awake)技术应用于近指间关节松解术的治疗效果。方法自2019年1月至12月我科运用Wide-awake技术行关节松解术治疗10例(12指)近指间关节僵硬患者。其中断指再植术后5例(6指),近节骨折切开复位内固定术后5例(6指)。原始手术至此次手术时间为6~10个月,平均8个月。分别于局部麻醉操作时(第1针刺入皮肤时)、术中及术后24h,采用疼痛视觉模拟评分(VAS)评价患者疼痛情况;术后采用TAM标准评定手指活动功能恢复情况。结果术中止血效果及麻醉效果满意,患者能完全配合术者进行手指主动活动。局麻操作时有不同程度疼痛感(VAS评分1~4分),术中无疼痛(VAS评分0分),术后有不同程度疼痛(VAS评分1~7分)。术后切口均I期愈合。所有病例均获得随访,时间8~14个月,平均12个月。手指活动功能均有明显改善,末次随访时骨折内固定术后患者功能评定为优4指、良2指;断指再植术后患者功能评定为优2指、良2指、可2指。结论Wide-awake技术应用于指间关节松解术治疗指间关节僵硬,术中通过患者主动活动,准确判断僵硬情况及松解程度,达到彻底松解的目的,治疗效果满意。Objective To introduce the clinical efficacy of wide-awake technique applied to the arthrolysis of proximal interphalangeal joint.Methods From January to December 2019,10 patients(12 fingers)with proximal interphalangeal joint stiffness were treated by arthrolysis using wide-awake technology in our department.Among them,there were 5 cases(6 fingers)after replantation of severed fingers and 5 cases(6 fingers)after open reduction and internal fixation of proximal phalangeal fractures.The time from the original operation to this operation was 6 to 10 months,with an average of 8 months.The patients'pain was evaluated by visual analogue scale(VAS)during local anesthesia(when the first needle was inserted into the skin),during operation and 24 hours after operation.The recovery of finger movement function was evaluated by TAM standard.Results The hemostatic effect and anesthetic effect were satisfactory during the operation,and the patient could fully cooperate with the operator in active finger movements.There were different degrees of pain during local anesthesia(VAS 1 to 4),no pain during operation(VAS O),and different degrees of pain after operation(VAS 1 to 7).All incisions achieved primary healing.All the cases were follow-up for 8 to 14 months,with an average of 12 months.The finger movement function was significantly improved.At the last follow-up,the function of patients after fracture internal fixation was evaluated as excellent in 4 fingers and good in 2 fingers.After replantation of severed fingers,the functional evaluation of patients was excellent in 2 fingers,good in 2 fingers and fair in 2 fingers.Conclusion The wide-awake technique is applied to the treatment of interphalangeal joint stiffness by arthrolysis of proximal interphalangeal joint.During the operation,the stiffness and the degree of release can be accurately judged through the patient's active movement,so as to achieve the goal of complete release,and the treatment effect is satisfactory.

关 键 词：麻醉 治疗结果 近指间关节 关节松解 完全清醒 

分 类 号：R687.4[医药卫生—骨科学]