完全清醒无止血带局部止血麻醉(WALANT)在手肌腱手术中的应用

摘要

Objecttive To introduce the wide awake local anesthesia no tourniquet (WALANT) technique in tendon surgery of the hand and to investigate its clinical results.Methods Between April 2013 and May 2014,32 patients were treated with WALANT technique,including 22 cases of tenorrhaphy,2 cases of tendon transposition,3 cases of tendon grafting,and 5 cases of tenolysis.The visual analogue scale (VAS) score was used to evaluate the pain of the injection,pre-and post-operative pain.Intraoperatively,bleeding at the surgery site was assessed.Active full range finger extension-flexion test was performed to evaluate tendon gliding,tendon stain and gap formation during the operation so adjustment could be made if necessary.Postoperatively,blood supply of the skin and anesthesia complications were observed.Functional recovery and the postoperative complications were evaluated during follow-up.Results The WALANT technique had good haemostatic effectiveness and pain control (VAS score:0) during the operation.All the patients felt pain of only the first poke during injection (VAS score:1 to 4),and various degrees of pain postoperatively (VAS score:0 to 7).This technique did not restrict the active movement so the extension-flexion test could be performed successfully to evaluate the effects of the operation in real-time.There were no anesthetic complications nor skin necrosis after the surgery.Twenty-seven cases were follow-up for more than 3 months.There was no tendon rupture nor changes of tendon tension in these patients.Total active motion (TAM) was used to assess finger functions in 20 cases with tendon injuries of the hand and revealed a 76.2 ％ excellent and good rate.Conclusion The WALANT technique is safe,effective and cost-efficient in tendon surgeries of the hand.The clinical results are good.%目的 介绍完全清醒无止血带局部止血麻醉(WALANT)技术在手外科肌腱手术中的应用范围和使用方法,探讨其临床效果.方法 2013年4月至2014年5月采用WALANT技术行手外科肌腱手术32例,其中肌腱修复22例,肌腱转位2例,肌腱移植3例,肌腱松解5例.使用视觉模拟评分法(VAS)对术前的注射痛、术中和术后的疼痛进行评估;术中评估术区出血情况,并行主动全幅手指伸屈试验检查修复肌腱的滑动、张力和缝合处间隙情况来确定是否需要相应的调整和处理;术后观察术区皮肤血供和麻醉并发症,并随访功能恢复情况和术后并发症.结果 WALANT技术有较好的术中止血效果并使术中操作无疼痛(VAS评分0),术前注射时仅有第一针的疼痛(VAS评分1 ～4),术后疼痛变异较大(VAS评分0～7).此技术不影响患肢(指)的主动运动功能,术中可行手指伸屈试验实时动态评估肌腱手术效果.术后未出现麻醉并发症和术区皮肤缺血坏死.术后3个月以上成功随访27例患者均未发现肌腱断裂和肌腱张力改变,按照手指关节总活动度(TAM)评估标准对其中20例手部肌腱损伤患者的手指活动度进行测量和评估,其优良率为76.2％.结论 WALANT技术应用于手外科肌腱手术安全有效、性价比高,可得到较好的临床效果.