清醒局部麻醉无止血带及地塞米松（WALANT-D）用于重度腕管综合征改良Camitz对掌成形术——30例回顾性研究
Wide-awake local anesthesia no tourniquet and dexamethasone (WALANT-D) for modified Camitz opponens plasty in severe carpal tunnel syndrome-a retrospective study of 30 cases.
作者信息
Jerome J Terrence Jose
机构信息
Olympia Hospital & Research Centre, Trichy, Tamilnadu, India.
出版信息
J Clin Orthop Trauma. 2023 Jul 22;43:102228. doi: 10.1016/j.jcot.2023.102228. eCollection 2023 Aug.
BACKGROUND
To analyze the outcome of modified Camitz opponens plasty using the wide-awake local anesthesia no tourniquet with dexamethasone (WALANT-D) technique in severe carpal tunnel syndrome (CTS).
METHODS
A retrospective review was performed in 30 hands of 27 patients who underwent Camitz opponens plasty for severe CTS between 2019 and 2021. All patients had 8 mg of dexamethasone mixed with WALANT. Preoperative active palmar abduction, grip strength, side, and pulp pinch strength, Kapandji score, and electrophysiological assessment of compound muscle action potential (CMAP) for abductor pollicis brevis (APB) were compared with the postoperative values. The palmaris longus had dual insertion into the abductor pollicis brevis and extensor expansion. The time interval of post-operative pain-free was noted. The Disabilities of the Arm, Shoulder, and Hand (DASH) and Carpal Tunnel Syndrome instrument (CTSI) also assessed the functional outcome.
RESULTS
The mean age of patients was 35 years (range 32-58 years). There were five male and 22 female patients. Of the female patients, three females had severe bilateral CTS. Twenty right and ten left hands were affected. The mean follow-up of our study was 12.5 months (range 10-14 months). The patients were pain-free for an average of 19.5 h postoperatively. There was a significant improvement in the thumb palmar abduction, grip strength, side, and pulp pinch strength, DASH score, CTSI, and APB-CMAP (p < 0.05) at the final follow-up.
CONCLUSIONS
Modified Camitz opponens plasty with a dual insertion into APB and extensor expansion effectively improves thumb opposition and daily activities. The tendon tensioning, checking the pulley impingement, appreciation of active movements, and a comfortable patient operative experience are advantages of the WALANT. Adding dexamethasone as an adjuvant to WALANT prolongs the analgesia and duration of the nerve block.
LEVEL OF EVIDENCE
IV, Retrospective case study.
背景
分析在严重腕管综合征（CTS）中使用含地塞米松的清醒局部麻醉无止血带（WALANT-D）技术进行改良Camitz对掌成形术的结果。
方法
对2019年至2021年间因严重CTS接受Camitz对掌成形术的27例患者的30只手进行回顾性研究。所有患者均将8毫克地塞米松与WALANT混合使用。将术前拇指主动掌侧外展、握力、侧捏力和指尖捏力、Kapandji评分以及拇短展肌（APB）复合肌肉动作电位（CMAP）的电生理评估结果与术后值进行比较。掌长肌有双重附着，分别附着于拇短展肌和伸肌扩张部。记录术后无痛的时间间隔。上肢、肩部和手部功能障碍（DASH）和腕管综合征评估工具（CTSI）也用于评估功能结果。
结果
患者的平均年龄为35岁（范围32 - 58岁）。有5名男性和22名女性患者。在女性患者中，3名女性患有严重双侧CTS。20只右手和10只左手受累。本研究的平均随访时间为12.5个月（范围10 - 14个月）。患者术后平均19.5小时无痛。在最后随访时，拇指掌侧外展、握力、侧捏力和指尖捏力、DASH评分、CTSI以及APB - CMAP均有显著改善（p < 0.05）。
结论
改良Camitz对掌成形术双重附着于APB和伸肌扩张部可有效改善拇指对掌功能和日常活动。肌腱张紧、检查滑车撞击、评估主动活动以及患者舒适的手术体验是WALANT的优点。在WALANT中添加地塞米松作为辅助剂可延长镇痛时间和神经阻滞持续时间。
证据级别
IV，回顾性病例研究。
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