WALANT技术在腱鞘松解术中的应用

Application of WALANT technique in tendon sheath release

目的 介绍在完全清醒时的无止血带止血局麻技术(Wide awake local anesthesia no tourniquet,WALANT)在腱鞘松解术中的应用。方法 2019年5月-2020年4月对收治的27例Ⅲ度或病程>6个月的Ⅱ度狭窄性腱鞘炎患者,应用WALANT技术行腱鞘松解术,术后即刻开始主动功能训练,2周拆线。术前的注射疼痛和术中的疼痛均使用数字评分法(VAS)评估;术中评估术野出血情况;术后观察麻醉不良反应和手术切口周围皮肤血供、记录手指总活动度(Total active motion, TAM)及上肢功能评定表(Disability of the arm, shoulder and hand questionnaire, DASH量表)评价关节活动度;末次随访使用Jamar测力计测量双手握力。结果 VAS评分术前注射时仅第一针轻度疼痛2.3分(范围1~3分),术中无疼痛,评分0.9分(0~2分)。患者均未出现头痛、头晕、恶心、呕吐等麻醉不良反应及甲床苍白、充盈时间延长、温度降低等患指远端供血障碍。术中出血少,平均约2.0 mL。DASH评分均值2.7分(0~5分),TAM均值272.8°(240°~300°),Jamar平均握力43.5 kg(35.0~59.0 kg)。结论 WALANT技术在腱鞘松解术中应用安全,无需止血带,可起到良好的止血作用。手术无疼痛,操作简单,有利于开展门诊手术;术后早期即可功能训练,手功能恢复满意。

Objective To introduce the application of wide awake local anesthesia no tourniquet(WALANT) in tendon sheath release. Methods From May 2019 to April 2020, 27 patients with grade III or more than half a year of grade II stenosing tenosynovitis were treated. Active functional exercise was started immediately after operation, and stitches were removed 2 weeks later. Preoperative injection pain and intraoperative pain were evaluated by VAS, intraoperative bleeding was evaluated, postoperative adverse reactions and skin blood supply around the incision were observed, and the total active motion(TAM) of fingers and the disability of the arm, shoulder and Hand questionnaire were recorded, At the last follow-up, the grip strength of both hands was measured with Jamar dynamometer. Results The VAS score was only 2.3 points(range 1-3) for mild pain at the first injection before operation, and 0.9points(range 0-2) for no pain during operation. There were no adverse reactions such as headache,dizziness, nausea, vomiting, pale nail bed, prolonged filling time, decreased temperature and so on. The average amount of bleeding was about 2 ml. The mean DASH score was 2.7(range 0-5);The mean Tam was 272.8 degrees(range 240-300 degrees), and the grip strength of Jamar was 43.5kg(range 35-59kg). Conclusion The application of WALANT technology in tendon sheath release is safe, without tourniquet, and can play a good hemostatic role in hemostasis. The operation is painless and simple,which is conducive to the development of outpatient surgery. Early postoperative functional exercise,hand function recovery is satisfactory.