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舟状骨假关节手术采用清醒局部麻醉无止血带(WALANT)与腋路阻滞麻醉的管理:患者满意度比较

Management of Scaphoid Pseudoarthrosis Surgery with Wide-Awake Local Anesthesia No Tourniquet (WALANT) Versus Axillary Block Anesthesia: Comparison of Patient Satisfaction.

作者信息

Altaş Okyar, Bayram Serkan, Aydin Ahmet Serhat, Ayik Ömer, Durmaz Hayati

机构信息

Department of Hand and Microsurgery, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey.

Department of Orthopaedics and Traumatology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey.

出版信息

Plast Surg (Oakv). 2024 Nov;32(4):638-645. doi: 10.1177/22925503231157092. Epub 2023 Mar 17.

Abstract

We aimed to compare clinical and functional results of treatment of scaphoid pseudoarthrosis between patients undergoing wide-awake local anesthesia no tourniquet (WALANT) versus axillary block anesthesia. The patients diagnosed with scaphoid non-union who underwent pseudoarthoris surgery were divided into WALANT group (  =  12) and axial block group (  =  11). Visual analog scores (VAS) were measured by calling the patients via phone on postoperative days 1, 2, 3, and 7. The VASs were also measured on the 14 day during patient check-ups. At the end of 12 months, Michigan Hand Questionnaire was used to assess clinical recovery. Bone union rate and surgery time were also investigated. Radiological and clinical examinations were compared between the groups. Eleven patients (91.7%) in the WALANT group and 10 patients (90.9%) in the axillary block group achieved bone union (  =  .94). Although there was no significant difference in preoperative VAS score between the groups, the WALANT group had significantly lower VAS score of the first 3 days postoperatively. However, there was no significant difference in VAS score between the groups on the seventh and 14 day postoperatively. There was no significant difference between the groups regarding Michigan score, time to surgery, time to union and operation time. The scaphoid pseudoarthrosis surgery can be done safely with WALANT technique which has significant lower VAS score on the first 3 days postoperatively.

摘要

我们旨在比较在无止血带的清醒局部麻醉(WALANT)与腋路阻滞麻醉下治疗舟状骨假关节的临床和功能结果。将诊断为舟状骨不愈合并接受假关节手术的患者分为WALANT组(n = 12)和腋路阻滞组(n = 11)。在术后第1、2、3和7天通过电话联系患者测量视觉模拟评分(VAS)。在患者复诊的第14天也测量VAS。在12个月末,使用密歇根手功能问卷评估临床恢复情况。还研究了骨愈合率和手术时间。比较两组之间的影像学和临床检查结果。WALANT组11例患者(91.7%)和腋路阻滞组10例患者(90.9%)实现了骨愈合(P = 0.94)。虽然两组术前VAS评分无显著差异,但WALANT组术后前3天的VAS评分显著更低。然而,术后第7天和第14天两组的VAS评分无显著差异。两组在密歇根评分、手术时间、愈合时间和手术时长方面无显著差异。采用WALANT技术进行舟状骨假关节手术是安全的,且术后前3天VAS评分显著更低。

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