完全清醒的无止血带局部麻醉技术治疗儿童扳机拇在高海拔地区的应用  

Application of WALANT technique in treating trigger thumb in children in high-altitude areas

作　　者：谢东可 沈恺颖[2] 廖红 张德双 徐蕴岚[2] Xie Dongke;Shen Kaiying;Liao Hong;Zhang Deshuang;Xu Yunlan(Department of Pediatric Surgery,Affiliated Hospital of Southwest Medical University,Luzhou 646000,China;National Children's Medical Center,Department of Pediatric Orthopedics,Shanghai Children's Medical Center,School of Medicine,Shanghai Jiao Tong University,Shanghai 200127,China;Department of Surgery,People's Hospital of Rangtang County,Aba Tibetan and Qiang Autonomous Prefecture 624000,China;Department of Pediatrics,Affiliated Hospital of Southwest Medical University,Luzhou 646000,China)

机构地区：[1]西南医科大学附属医院小儿外科,泸州646000 [2]国家儿童医学中心,上海交通大学医学院附属上海儿童医学中心骨科,上海200127 [3]壤塘县人民医院外科,阿坝藏族羌族自治州624000 [4]西南医科大学附属医院儿科,泸州646000

出　　处：《中华手外科杂志》2025年第1期33-36,共4页Chinese Journal of Hand Surgery

基　　金：上海市卫生和健康委员会面上项目(202340207);上海市科学技术委员会“科技创新行动计划”医学创新研究专项项目(22Y11912300)。

摘　　要：目的:探讨在高海拔地区采用家属陪伴下完全清醒的无止血带局部麻醉(wide-awake local anesthesia with no tourniquet,WALANT)行A1滑车松解治疗儿童扳机拇的临床效果。方法:回顾性分析自2022年1月至2023年4月就诊于川西高原壤塘县人民医院(海拔3285 m)的16例长期生活在当地的藏族扳机拇患儿临床资料,共17拇,Sugimoto分期Ⅲ期2拇、Ⅳ期15拇。所有患儿均在家属陪伴下采用WALANT技术行A1滑车松解和患拇滑车部分切除术。结果:在家属陪伴下所有患儿均顺利完成手术,术中疼痛FLACC行为评分为(0.63±0.62)分,患儿配合及止血效果满意,腱鞘松解后主动配合检查拇指屈伸功能。术中手术区域软组织轻度水肿,术野清晰出血少,不影响手术操作;术后术区皮肤无坏死,均Ⅰ期愈合,无麻醉不良反应。术后随访时间为4~7个月,平均(5.56±1.09)个月,所有患儿均恢复良好,无复发、拇指疼痛、麻木和弓弦畸形等并发症。结论:WALANT技术为儿童扳机拇的治疗提供了一种安全、有效的新方式。局部麻醉良好的止血效果能满足患儿手术需要,且有家属陪伴给予患儿足够的安全感,可在家属引导下主动屈伸活动拇指,明确松解效果,操作简单方便。Objective:To investigate the clinical efficacy of A1 pulley release surgery for the treatment of pediatric trigger thumb under under wide-awake local anesthesia with no tourniquet(WALANT)accompanied by family members in children in high-altitude areas.Methods:A retrospective analysis was conducted on the clinical data of 16 Tibetan children with trigger thumb who had been living locally for a long time and were treated at the People′s Hospital of Rangtang County,Western Sichuan Plateau(altitude 3285 meters)from January 2022 to April 2023.The total number of trigger thumb in children was 17,with Sugimoto stageⅢin 2 thumbs and stageⅣin 15 thumbs.All patients underwent A1 pulley release and partial removal of the affected thumb pulley using the WALANT technique accompanied by their families.Results:With the accompaniment of family members,all the children successfully completed the surgery.The FLACC behavioral score for intraoperative pain was(0.63±0.62)points.The children cooperated and showed satisfactory hemostatic effects.After releasing the tendon sheath,they actively cooperated with the examination of thumb flexion and extension function.Mild edema of soft tissue occurred in the surgical area during surgery,and surgical field was clear with minimal bleeding,which did not affect surgical operation.There was no necrosis of the skin in the postoperative area,and all cases achieved primary healing without any adverse anesthesia reactions.The postoperative follow-up time was 4 to 7 months,with an average of(5.56±1.09)months.All patients recovered well without complications such as recurrence,thumb pain,numbness,and bowstring deformity.Conclusion:WALANT technique provides a safe and effective new approach for the treatment of trigger thumb in children.The good hemostatic effect of local anesthesia can meet the surgical needs of pediatric patients,and the presence of family members provides sufficient sense of security.Under the guidance of family members,the patient can actively flex and extend the thumb to

关 键 词：儿童 扳机指症 WALANT技术 腱鞘松解术 

分 类 号：R726.8[医药卫生—儿科]