Christensen Anette B, IIkjær Christine, Laustrup Torben K, Sejer Esben, Rønnøw Camilla, Døssing Kaj V, Jensen Troels B, Andersen Jacob K, Sølling Christoffer G
Department of Anaesthesiology and Intensive Care, Gødstrup Regional Hospital, Herning, Denmark.
Department of Anaesthesiology and Intensive Care, Viborg Regional Hospital, Viborg, Denmark.
Acta Anaesthesiol Scand. 2025 Jul;69(6):e70063. doi: 10.1111/aas.70063.
The initial treatment for distal forearm fractures, including Colles' fractures, involves closed reduction, for which effective pain management is essential. In Colles' fractures, achieving a satisfactory closed reduction may eliminate the need for surgical intervention. While ultrasound-guided nerve blocks are effective, hematoma blocks (HB) are often favored due to their feasibility in the emergency care setting. Further research comparing treatment outcomes is warranted.
In a multicentre randomised controlled trial, adults with distal forearm fractures were assigned to either ultrasound-guided blocks of the radial and median nerves (US) or HB for closed fracture reduction. The primary endpoint was satisfactory fracture reduction. Secondary endpoints were secondary fracture dislocation, self-reported pain, and time spent in the emergency department.
Among 238 patients with Colles' fracture, 117 received US and 121 received HB. Satisfactory fracture reduction was achieved in 73 (62%) and 49 (40%) patients, respectively (p = 0.01). Surgical correction was conducted in 61 (52%) patients in the US group, contrasting 80 (66%) patients in the HB group (p = 0.03). During the fracture reduction, no difference in self-reported pain was observed (p = 0.21) for patients with distal forearm fractures (n = 247). The median time from block application to fracture reduction was 45 min in the US group and 25 min in the HB group (p < 0.01).
Ultrasound-guided median and radial nerve blocks had a higher success rate for Colles' fracture reduction than the hematoma block group. The influence of anesthetic techniques on the eventual need for surgery requires further investigation.
包括科雷氏骨折在内的前臂远端骨折的初始治疗包括闭合复位，有效的疼痛管理对此至关重要。在科雷氏骨折中，实现满意的闭合复位可能无需手术干预。虽然超声引导下神经阻滞有效，但血肿阻滞（HB）因其在急诊环境中的可行性而常受青睐。有必要进行进一步研究比较治疗效果。
在一项多中心随机对照试验中，将患有前臂远端骨折的成年人分配至接受超声引导下桡神经和正中神经阻滞（US）或血肿阻滞以进行骨折闭合复位。主要终点是骨折复位满意。次要终点是继发性骨折脱位、自我报告的疼痛以及在急诊科的停留时间。
在238例科雷氏骨折患者中，117例接受了US，121例接受了HB。分别有73例（62%）和49例（40%）患者实现了满意的骨折复位（p = 0.01）。US组有61例（52%）患者进行了手术矫正，而HB组为80例（66%）患者（p = 0.03）。在前臂远端骨折患者（n = 247）中，骨折复位期间自我报告的疼痛无差异（p = ）。US组从阻滞应用到骨折复位的中位时间为45分钟，HB组为25分钟（p < 0.01）。
超声引导下正中神经和桡神经阻滞在科雷氏骨折复位方面的成功率高于血肿阻滞组。麻醉技术对最终手术需求的影响需要进一步研究
