CAJ | 학술논문

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.
목적 개소완전청성무지혈대국부지혈마취(WALANT)기술재수외과기건수술중적응용범위화사용방법,탐토기림상효과.방법 2013년4월지2014년5월채용WALANT기술행수외과기건수술32례,기중기건수복22례,기건전위2례,기건이식3례,기건송해5례.사용시각모의평분법(VAS)대술전적주사통、술중화술후적동통진행평고;술중평고술구출혈정황,병행주동전폭수지신굴시험검사수복기건적활동、장력화봉합처간극정황래학정시부수요상응적조정화처리;술후관찰술구피부혈공화마취병발증,병수방공능회복정황화술후병발증.결과 WALANT기술유교호적술중지혈효과병사술중조작무동통(VAS평분0),술전주사시부유제일침적동통(VAS평분1 ～4),술후동통변이교대(VAS평분0～7).차기술불영향환지(지)적주동운동공능,술중가행수지신굴시험실시동태평고기건수술효과.술후미출현마취병발증화술구피부결혈배사.술후3개월이상성공수방27례환자균미발현기건단렬화기건장력개변,안조수지관절총활동도(TAM)평고표준대기중20례수부기건손상환자적수지활동도진행측량화평고,기우량솔위76.2％.결론 WALANT기술응용우수외과기건수술안전유효、성개비고,가득도교호적림상효과.
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.