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应用 WALANT 技术治疗桡骨远端骨折。

Applying the WALANT technique to surgical treatment of distal radius fractures.

机构信息

Chirurgie Orthopédique Membre Supérieur, Hôpital Avicenne - Université Sorbonne Paris Nord, 125 Rue de Stalingrad, 93000 Bobigny, France; MOVEO Institute, University, University Paris Seine-Saint-Denis, 11 Rue de Cambrai Immeuble 028, 75019 Paris, France.

Chirurgie Orthopédique Membre Supérieur, Hôpital Avicenne - Université Sorbonne Paris Nord, 125 Rue de Stalingrad, 93000 Bobigny, France; MOVEO Institute, University, University Paris Seine-Saint-Denis, 11 Rue de Cambrai Immeuble 028, 75019 Paris, France.

出版信息

Hand Surg Rehabil. 2021 Jun;40(3):277-282. doi: 10.1016/j.hansur.2021.02.001. Epub 2021 Feb 23.

Abstract

The Wide-Awake Local Anesthesia No Tourniquet (WALANT) method is a recent anesthesia option for surgery of the upper limbs based on the injection of an anesthetic solution containing adrenaline at the surgical site, hence circumventing tourniquet use. In a prospective study, we compared the functional outcomes using this anesthesia technique with those of the regional anesthesia (RA) technique for the surgical care of distal radius fractures (DRF). From November 2019 to June 2020, a non-randomized, single-center study was conducted with a cohort of 41 patients suffering from a DRF and who received volar plate fixation at a university hospital center. Twenty-one patients had WALANT surgery and 20 had RA with installation of a tourniquet. Over a period of 7 months, the clinical and radiological outcomes as well as the QuickDASH functional score were evaluated. Recovery of wrist function return to work, and analgesic withdrawal for the WALANT group occurred earlier than for the RA group. No noticeable differences were found regarding surgery duration or radiographic results. Using WALANT, functional wrist recovery occurs earlier than with RA. In our study, earlier analgesic stoppage, a quicker return to work and resumption of activity were observed with WALANT. As such, it should become part of the therapeutic arsenal for surgical treatment of DRF.

摘要

清醒镇静无止血带(WALANT)麻醉方法是一种新的上肢手术麻醉选择,其基于在手术部位注射含有肾上腺素的麻醉溶液,从而避免使用止血带。在一项前瞻性研究中,我们比较了使用这种麻醉技术与区域麻醉(RA)技术对桡骨远端骨折(DRF)进行手术治疗的功能结果。从 2019 年 11 月至 2020 年 6 月,在一所大学医院中心进行了一项非随机、单中心研究,共纳入 41 例患有 DRF 并接受掌侧钢板固定的患者。21 例患者接受 WALANT 手术,20 例患者接受带止血带的 RA。在 7 个月的时间内,评估了临床和放射学结果以及 QuickDASH 功能评分。WALANT 组的腕部功能恢复、重返工作和停止镇痛的时间早于 RA 组。手术时间或影像学结果无明显差异。与 RA 相比,使用 WALANT 时腕关节功能恢复更早。在我们的研究中,与 RA 相比,WALANT 更早停止镇痛,更快恢复工作和恢复活动。因此,它应该成为 DRF 手术治疗的治疗武器库的一部分。

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