Department of Orthopedic Surgery, NYU Langone Orthopedic Hospital, New York, NY, USA.
Department of Orthopedic Surgery, NYU Langone Orthopedic Hospital, New York, NY, USA; Department of Orthopedic Surgery, Jamaica Hospital Medical Center, Jamaica, NY, USA.
Injury. 2019 Mar;50(3):671-675. doi: 10.1016/j.injury.2019.01.013. Epub 2019 Jan 14.
The purpose of this study was to determine the effect of regional anaesthesia as compared to general anaesthesia on clinical, functional, and radiographic outcomes following long bone fracture nonunion repair.
262 patients who underwent operative repair of a long bone fracture nonunion and had at least 12 months of post-operative follow up were included in this study. Functional outcomes were assessed prospectively using the Short Musculoskeletal Function Assessment (SMFA) and Visual Analog Scale (VAS) pain scores prior to nonunion repair and at routine intervals post-operatively. Patients were divided into two matched groups based upon the type of anaesthetic method used in surgery. The regional anaesthesia cohort was composed of all patients who received regional anaesthesia (spinal anaesthesia or peripheral nerve block) alone or in addition to general anaesthesia, while patients who received general anaesthesia alone made up the general anaesthesia cohort. Univariate and multivariate analyses were performed to examine the effect of anaesthesia type on functional outcome scores, post-operative pain, bony healing, and complication rate.
The regional anaesthesia and general anaesthesia cohorts each consisted of 131 patients. Multiple linear regression demonstrated there to be no significant association between anaesthetic method and total SMFA scores at all post-operative time points. Additionally, anaesthetic method was not associated with post-operative VAS pain scores, time to union, or the rate of post-operative complications.
In this cohort, the use of regional anaesthesia during operative repair of long bone fracture nonunion was associated with no significant difference in functional outcome scores or pain levels at all post-operative time points. Furthermore, the use of regional anaesthesia had no effect on the rate of post-operative complications. Either type of anaesthetic appears to be safe and effective in performing these surgeries.
本研究旨在比较区域麻醉与全身麻醉对长骨骨折不愈合修复后临床、功能和影像学结果的影响。
本研究纳入了 262 例接受长骨骨折不愈合手术修复且术后随访至少 12 个月的患者。在非愈合修复前和术后常规间隔使用短肌肉骨骼功能评估（SMFA）和视觉模拟评分（VAS）疼痛评分对功能结果进行前瞻性评估。根据手术中使用的麻醉方法将患者分为两组：区域麻醉组包括仅接受区域麻醉（椎管内麻醉或周围神经阻滞）或联合全身麻醉的所有患者，而仅接受全身麻醉的患者则构成全身麻醉组。进行单变量和多变量分析以检查麻醉类型对功能结果评分、术后疼痛、骨愈合和并发症发生率的影响。
区域麻醉组和全身麻醉组各有 131 例患者。多元线性回归分析表明，在所有术后时间点，麻醉方法与 SMFA 总分之间均无显著关联。此外，麻醉方法与术后 VAS 疼痛评分、愈合时间或术后并发症发生率均无相关性。
在本队列中，在长骨骨折不愈合修复手术中使用区域麻醉与所有术后时间点的功能结果评分或疼痛水平无显著差异相关。此外，区域麻醉的使用对术后并发症的发生率没有影响。两种类型的麻醉在进行这些手术时似乎都是安全有效的。
