Nelson Rebecca, Higgins Amanda, Conrad Joanie, Bell Mike, Lalonde Don
Hand (N Y). 2010 Jun;5(2):117-24. doi: 10.1007/s11552-009-9239-y. Epub 2009 Nov 10.
The Wide-Awake Approach to Dupuytren's contracture involves fasciectomy under local anesthetic with epinephrine and no tourniquet. The goal of this study is to show that the Wide-Awake Approach produces equivalent outcomes to fasciectomy under general anesthetic with a tourniquet, with fewer risks to the patient. A multicenter retrospective review was conducted on 111 patients with fasciectomies under local or general anesthetic between 2001 and 2007. Data on patient demographics, comorbidities, cost, as well as range of motion was collected and evaluated using Microsoft Excel and SAS. Of 148 fingers, 102 were treated under local and 46 under general anesthetic. The average postoperative Total Active Motion (TAM) for general anesthetic patients was 199.0 ± 29.6 (D5), 223.9 ± 29.3 (D4), 234.6 ± 14.6 (D3), and 246.7 ± 14.4 (D2). The average postoperative TAM for local anesthetic patients was 168.3 ± 62.2 (D5), 195.9 ± 67.5 (D4), 173.0 ± 72.6 (D3), and 177.5 ± 31.8 (D2). There were no significant differences between any of these individual groups (p = 0.09, 0.26, 0.12, and 0.20, respectively); however, when pooled, the overall TAM was significantly greater in the general anesthesia group (222.0 ± 29.7 vs. 186.0 ± 63.0, p = 0.002.). Complication rates and types were similar with both techniques. The Wide-Awake Approach to Dupuytren's contracture avoids general anesthetic risks and has cost benefits to healthcare providers. Although it yields similar range of motion outcomes to fasciectomy performed under general anesthesia, total active motion may be better with fasciectomy done under general anesthesia.
“清醒局麻”治疗掌腱膜挛缩症的方法是在局部麻醉并加肾上腺素的情况下进行筋膜切除术，且不使用止血带。本研究的目的是表明“清醒局麻”方法能产生与在全身麻醉并使用止血带情况下进行筋膜切除术相当的治疗效果，同时给患者带来更少的风险。对2001年至2007年间111例行局部或全身麻醉下筋膜切除术的患者进行了多中心回顾性研究。收集了患者人口统计学、合并症、费用以及关节活动度等数据，并使用微软Excel和SAS软件进行评估。在148根手指中，102根接受了局部麻醉治疗，46根接受了全身麻醉治疗。全身麻醉患者术后平均总主动活动度（TAM）为：小指（D5）199.0±29.6、环指（D4）223.9±29.3、中指（D3）234.6±14.6、示指（D2）246.7±14.4。局部麻醉患者术后平均TAM为：小指（D5）168.3±62.2、环指（D4）195.9±67.5、中指（D3）173.0±72.6、示指（D2）177.5±31.8。这些个体组之间均无显著差异（p值分别为0.09、0.26、0.12和0.20）；然而，合并计算时，全身麻醉组的总体TAM显著更高（222.0±29.7对186.0±63.0，p = 0.002）。两种技术的并发症发生率和类型相似。“清醒局麻”治疗掌腱膜挛缩症的方法避免了全身麻醉的风险，且对医疗服务提供者具有成本效益。虽然它产生的关节活动度结果与全身麻醉下进行的筋膜切除术相似，但全身麻醉下进行筋膜切除术的总主动活动度可能更好。
