感觉和运动分离的臂丛神经阻滞麻醉在手指屈肌腱粘连松解术中的应用效果

The application of motor nerve and sensory nerve separate block of brachial plexus block anesthesia in tenolysis of flexor tendon adhesion of the fingers

目的探讨屈肌腱粘连松解手术中应用感觉和运动分离的臂丛神经阻滞麻醉的方法及效果。方法 2012年4月-2018年5月,对32例肌腱粘连患者于超声和神经刺激仪引导下使用低浓度罗哌卡因臂丛神经阻滞麻醉,术中仅阻滞感觉神经,麻醉起效后开始肌腱松解术,术中可通过观察患指的主动活动来确定肌腱松解是否彻底。结果 1例2指术后1周出现松解肌腱的断裂,二次手术重建;余31例42指切口全部愈合。术后48 h根据TAM系统评定法评价肌腱松解优良率为83.3%(35指)。18例随访3~12个月,平均6个月,患指屈曲活动范围均较前改善,范围达160°~260°,平均210°,根据TAM系统评定法评价:优9指,良14指,可2指,优良率达92.0%。结论利用感觉和运动分离的臂丛神经阻滞麻醉能够明确术中肌腱是否完全松解,可取得良好的临床效果。

Objective To report the application and treatment effect of brachial plexus block with motor and sensory separation in flexor tenolysis of the fingers. Methods Ultrasound-guided braehial plexus block with low concentration ropivacaine through all axillary approach was applied in 32 eases with tendon adhesion from April 2012 to May 2018. Only the sensory components were blocked during the operation and flexor tenolysis was performed after anesthesia was in effect.The effectiveness of tenolysis was judged by the active motion of the finger during the operation. Results After operation, the released tendon of two fingers in one case occurred rupture and needed another operation. The remaining wound healed smoothly. According to the standard functional evaluation issued by TAM, the excellent and good rate was 83.3% at 48 hours after operation. 18 patients were followed up for 3 to 12 months(average, 6 months). The function of total active flexor motion was improved obviously and the range was from 160°to 260°(average, 210°). The functional results assessed by TAM method were excellent in 9 fingers, good in 14 fingers and fair in 2 fingers. The excellent and good rate was 92.0%. Conclusion Brachial plexus block with only sensory blockade can effectively determine whether adhesive tendons are released completely during operation. It is beneficial to evaluate treatment effect of tenolysis during operation. The clinical results are good.