Departments of Orthopaedic Surgery, New York University Hospital for Joint Diseases, New York, NY 10003, USA.
J Bone Joint Surg Am. 2010 Feb;92(2):368-74. doi: 10.2106/JBJS.H.01852.
To our knowledge, no study to date has compared the use of spinal and general anesthesia in patients undergoing operative fixation of an unstable ankle fracture. The purpose of this study was to assess the effects of anesthesia type on postoperative pain and function in a large cohort of patients.
Between October 2000 and November 2006, 501 patients who underwent surgical fixation of an unstable ankle fracture were followed prospectively. Patients receiving spinal anesthesia were compared with a cohort who received general anesthesia. All patients were evaluated at three, six, and twelve months postoperatively with use of standardized, validated general and limb-specific outcome instruments. Standard and multivariable analyses comparing outcomes at these intervals were performed.
Four hundred and sixty-six patients (93%) who had been followed for a minimum of one year met the inclusion criteria. Compared with the general anesthesia group, the spinal anesthesia group had a greater mean age (p = 0.005), higher classification on the American Society of Anesthesiologists system (p = 0.03), and a greater number of patients with diabetes (p = 0.02). There was no difference in sex distribution between the groups. At three months, patients who received spinal anesthesia had significantly better pain scores (p = 0.03) and total scores on the American Orthopaedic Foot and Ankle Society outcome instrument (p = 0.02). At six months, patients in the spinal anesthesia group continued to have better pain scores (p = 0.04), but there was no longer a difference in total scores (p = 0.06). At twelve months, no difference was detected between the groups in terms of functional or pain scores. There was no difference in complication rates between the groups.
Patients who undergo fixation of an ankle fracture under spinal anesthesia seem to experience less pain and have better function in the early postoperative period. We recommend that, unless there is a specific contraindication, patients should be offered spinal anesthesia when undergoing operative fixation of an ankle fracture.
据我们所知，目前尚无研究比较过在不稳定踝关节骨折患者中应用椎管内麻醉和全身麻醉。本研究旨在评估大量患者中麻醉类型对术后疼痛和功能的影响。
2000 年 10 月至 2006 年 11 月，前瞻性随访了 501 例接受手术固定不稳定踝关节骨折的患者。椎管内麻醉组与接受全身麻醉的患者进行比较。所有患者术后均接受了 3、6 和 12 个月的评估，使用了标准化、有效的通用和肢体特定的结果评估工具。在这些时间点进行了比较结果的标准和多变量分析。
466 例（93%）至少随访 1 年的患者符合纳入标准。与全身麻醉组相比，椎管内麻醉组患者的平均年龄更大（p = 0.005），美国麻醉医师协会（ASA）分级更高（p = 0.03），糖尿病患者更多（p = 0.02）。两组之间的性别分布无差异。在 3 个月时，接受椎管内麻醉的患者疼痛评分显著更好（p = 0.03），美国矫形足踝协会（AOFAS）结果评分也更高（p = 0.02）。在 6 个月时，椎管内麻醉组患者的疼痛评分仍更好（p = 0.04），但总评分无差异（p = 0.06）。在 12 个月时，两组在功能或疼痛评分方面无差异。两组的并发症发生率无差异。
在接受椎管内麻醉的踝关节骨折固定患者术后早期疼痛较轻，功能更好。我们建议，除非有特定的禁忌证，否则应向接受踝关节骨折手术固定的患者提供椎管内麻醉。
