完全清醒无止血带局部麻醉技术在治疗急性跟腱断裂中的应用

Application of wide-awake local anesthesia no tourniquet technique in the treatment of acute Achilles tendon rupture

目的探讨完全清醒无止血带局部麻醉(wide-awake local anesthesia no tourniquet,WALANT)技术在治疗急性跟腱断裂中的应用价值。方法采用前瞻性随机对照研究,纳入2020年3月—10月符合选择标准的48例急性跟腱断裂患者,按1∶1分配方式应用随机数字表法分为两组,每组24例,研究组应用WALANT技术、对照组采用持续硬膜外麻醉附加止血带方式进行通道辅助微创缝合(channel-assisted minimally invasive repair,CAMIR)手术。两组患者性别、年龄、受伤侧别、致伤原因、跟腱断端至跟骨结节距离及受伤至住院时间比较差异均无统计学意义(P>0.05)。记录并比较两组患者手术室使用时间(患者进入手术室至离开手术室)、术中出血量、住院时间以及术中和术后1 d最高疼痛评分[采用数字疼痛分级法(NRS)],记录对照组出现止血带不良反应情况;术后12个月采用美国矫形足踝协会(AOFAS)评分评价功能恢复情况。结果两组患者均顺利完成手术。研究组手术室使用时间和住院时间显著少于对照组(P<0.05),但两组术中出血量比较差异无统计学意义(t=0.429,P=0.670)。两组术中最高NRS评分比较差异无统计学意义(t=1.671,P=0.101),术后1 d最高NRS评分研究组显著低于对照组(t=-6.384,P<0.001)。对照组共有13例患者术后出现不同程度的止血带不良反应,包括止血带区域疼痛、局部肿胀、出现水疱、大腿麻木不适等。两组患者均获随访,随访时间12~18个月,平均13.9个月。术后12个月所有患者运动功能均恢复正常,两组AOFAS评分比较差异无统计学意义(t=0.345,P=0.731)。两组患者均未发生腓肠神经损伤、局部感染、二次断裂等并发症。结论应用WALANT联合CAMIR技术治疗急性跟腱断裂,麻醉及治疗效果良好,避免了止血带的不良反应,合理节约了社会医疗资源。

Objective To explore the value of wide-awake local anesthesia no tourniquet(WALANT) technique in the treatment of acute Achilles tendon rupture. Methods In a prospective randomized controlled trial, 48 patients with acute Achilles tendon rupture who met the criteria between March 2020 and October 2020 were randomly divided into two groups according to 1∶1 distribution, with 24 cases in each group. The study group used WALANT technique and the control group used epidural anesthesia with tourniquet for channel-assisted minimally invasive repair(CAMIR).There was no significant difference between the two groups in gender, age, injured side, cause of injury, distance from broken end of Achilles tendon to calcaneal tubercle, and time from injury to hospitalization(P>0.05). The operating room use time(from patients entering the operating room to leaving the operating room), intraoperative blood loss, hospital stay, and the highest pain score [using Numerical Rating Scale(NRS)] during operation and at 1 day after operation were recorded and compared between the two groups. The tourniquet adverse reactions in the control group were recorded. The functional recovery was evaluated by the scoring method of American Orthopedic Foot and Ankle Society(AOFAS) at 12 months after operation. Results The operation was successfully completed in both groups. The operating room use time and hospital stay in the study group were significantly less than those in the control group(P<0.05), but the difference in the intraoperative blood loss between the two groups was not significant(t=0.429, P=0.670). There was no significant difference in the highest NRS score during operation between the two groups(t=1.671, P=0.101);the highest NRS score in the study group at 1 day after operation was significantly lower than that in the control group(t=-6.384, P<0.001). In the control group, 13 patients had different degrees of tourniquet adverse reactions, including tourniquet regional pain, local swelling, blisters, thigh numbness, and discomfort. The patients in both groups were followed up 12-18 months, with an average of 13.9 months. The motor function of all patients returned to normal at 12 months after operation. The difference in AOFAS scores between the two groups was not significant(t=0.345, P=0.731). There was no complication such as sural nerve injury, local infection, and secondary rupture in both groups. Conclusion The application of WALANT combined with CAMIR technique in the treatment of acute Achilles tendon rupture has good anesthetic and effectiveness, avoids the adverse reactions of tourniquet, and reasonably saves social medical resources.