使用 WALANT（清醒局部麻醉无止血带）技术治疗踝关节骨折固定：简陋环境下的诱人选择。

Ankle Fracture Fixation with Use of WALANT (Wide Awake Local Anesthesia with No Tourniquet) Technique: An Attractive Alternative for the Austere Environment.

出版信息

J Bone Joint Surg Am. 2021 Mar 3;103(5):397-404. doi: 10.2106/JBJS.20.00196.

DOI:10.2106/JBJS.20.00196

Abstract

BACKGROUND

Wide awake local anesthesia with no tourniquet (WALANT) is a simple technique that has had successful application in hand surgery. When utilized in the plating of distal radial fractures, the WALANT technique has proven to be a cost-effective approach in orthopaedic trauma. The aim of the present study was to assess the applicability of the WALANT technique in open reduction and internal fixation of ankle fractures.

METHODS

Fifty-eight patients were recruited from October 2016 to September 2018. Fractures were categorized according to the OTA/AO classification. We did not include patients with Maisonneuve, talar, or posterior malleolar fractures. Mechanism of injury, fracture type, comorbidities, and complications were recorded. The surgical site was infiltrated to achieve local anesthesia using a solution of 0.9% normal saline solution and 2% lidocaine with 1:1,000,000 epinephrine. Functional outcomes were assessed at the time of fracture union with use of the American Orthopaedic Foot & Ankle Society (AOFAS) Ankle-Hindfoot Scale.

RESULTS

Thirty-nine patients (67%) were male and 19 (33%) were female, and the mean age was 46.79 ± 8.54 years. According to the OTA/AO classification, 36 fractures (62%) were 44C2, 11 (19%) were 44B2, 7 (12%) were 44C1, and 4 (7%) were 44B1 fractures. Average blood loss was 29.40 ± 7.38 mL, the mean operative time was 59.72 ± 7.19 minutes, and the mean intraoperative visual analogue scale (VAS) for pain was 1.24 ± 0.43 (range, 0 to 3). The mean time to union was 16.21 ± 3.52 weeks, with a mean AOFAS Ankle-Hindfoot Scale score of 86.38 ± 5.72. Three patients (5.2%) developed nonunion of a fracture site, 2 patients had a surgical site infection, and 1 noncompliant diabetic patient developed osteomyelitis.

CONCLUSIONS

The WALANT technique is a safe technique for ankle fracture fixation and has been shown to be useful in foot and ankle surgery, particularly in limited-resource environments.

LEVEL OF EVIDENCE

Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

摘要

背景

无止血带清醒局麻（WALANT）是一种简单的技术，在手外科中已成功应用。当应用于桡骨远端骨折的钢板固定时，WALANT 技术已被证明是一种具有成本效益的骨科创伤方法。本研究旨在评估 WALANT 技术在踝关节骨折切开复位内固定中的适用性。

方法

2016 年 10 月至 2018 年 9 月期间共招募了 58 名患者。骨折根据 OTA/AO 分类进行分类。我们不包括 Maisonneuve、距骨或后踝骨折患者。记录了损伤机制、骨折类型、合并症和并发症。手术部位采用 0.9%生理盐水和 2%利多卡因与 1:1000000 肾上腺素混合溶液进行局部麻醉。骨折愈合时采用美国矫形足踝协会（AOFAS）踝关节-后足量表评估功能结果。

结果

39 名患者（67%）为男性，19 名（33%）为女性，平均年龄为 46.79±8.54 岁。根据 OTA/AO 分类，36 例（62%）为 44C2 型骨折，11 例（19%）为 44B2 型骨折，7 例（12%）为 44C1 型骨折，4 例（7%）为 44B1 型骨折。平均失血量为 29.40±7.38ml，平均手术时间为 59.72±7.19 分钟，术中视觉模拟评分（VAS）平均疼痛为 1.24±0.43（范围 0 至 3）。平均愈合时间为 16.21±3.52 周，AOFAS 踝关节-后足量表评分为 86.38±5.72。3 例（5.2%）患者骨折部位发生不愈合，2 例患者发生手术部位感染，1 例不遵守糖尿病患者发生骨髓炎。