Dukan Ruben, Krief Elie, Nizard Remy
Stroke Research Group department of clinical Neurosciences, University of Cambridge, Cambridge, UK.
J Hand Surg Eur Vol. 2020 Oct;45(8):857-863. doi: 10.1177/1753193420916418. Epub 2020 Apr 11.
Surgical fixation of distal radius fractures under local anaesthesia with the patient wide awake allows an intraoperative testing of the fixation stability under active mobilization. We evaluated the feasibility and clinical results of this technique in 45 patients prospectively in two matched comparable groups: wide-awake local anaesthesia no tourniquet and loco-regional anaesthesia. We found that the pain scores during the anaesthetic administration and the surgical procedure were similar in two groups. Ranges of wrist motion and QuickDASH scores were improved significantly in the wide-awake local anaesthesia no tourniquet group at 6 weeks and 3 months and similar at 6 months compared with those receiving loco-regional anaesthesia. Patients in wide-awake local anaesthesia no tourniquet returned to work significantly earlier than the loco-regional anaesthesia group. We conclude that osteosynthesis of distal radius fractures can be safely performed under wide-awake local anaesthesia no tourniquet, leading to no increase in pain level and similar functional outcomes compared with those under loco-regional anaesthesia. III.
在患者完全清醒的状态下对桡骨远端骨折进行局部麻醉下的手术固定，可在主动活动时对固定稳定性进行术中测试。我们前瞻性地评估了该技术在45例患者中的可行性和临床结果，将其分为两个匹配的可比组：完全清醒局部麻醉不使用止血带组和局部区域麻醉组。我们发现，两组在麻醉给药和手术过程中的疼痛评分相似。与接受局部区域麻醉的患者相比，完全清醒局部麻醉不使用止血带组在6周和3个月时腕关节活动范围和QuickDASH评分显著改善，6个月时相似。完全清醒局部麻醉不使用止血带组的患者比局部区域麻醉组更早重返工作岗位。我们得出结论，桡骨远端骨折的骨合成可以在完全清醒局部麻醉不使用止血带的情况下安全进行，与局部区域麻醉相比，不会导致疼痛水平增加，功能结果相似。III.
