WALANT麻醉下肌腱延长治疗前臂缺血性肌挛缩环小指屈曲畸形

Application of tendon lengthening under WALANT anesthesia in the treatment of ring finger and little finger flexion deformity caused by forearm ischemic contracture

目的观察应用完全清醒无止血带局部麻醉术(wide awake local anesthesia no tourniquet, WALANT)结合肌腱"Z"形延长术治疗成人晚期轻型前臂缺血性肌挛缩导致的环指、小指屈曲畸形的效果。方法我院自2015年6月至2020年8月收治晚期轻型前臂缺血性肌挛缩患者9例, 男5例, 女4例。在不使用止血带的情况下行WALANT麻醉, 20~30 min后开始肌腱"Z"形延长术。术后支具固定, 评分采用总主动活动度(total active motion, TAM)标准。结果术后9例患者均获得随访, 时间6~20个月, 平均12个月。术后患者恢复良好, 根据TAM评分术后平均优良率为100%。结论 WALANT麻醉结合肌腱"Z"形延长术对于晚期轻型前臂缺血性肌挛缩伴手指屈曲畸形有明确的治疗效果, 而且出血风险低, 术中可以随时观察手部活动, 有良好的治疗效果, 值得临床重视。

Objective To observe the effect of wide awake local anesthesia no tourniquet(WALANT)combined with tendon“Z”lengthening in the treatment of ring finger and little finger flexion deformity caused by late mild forearm ischemic muscle contracture in adults.MethodsFrom June 2015 to August 2020,9 patients with late mild forearm ischemic muscle contracture were treated in our hospital,including 5 males and 4 females.The WALANT anesthesia was performed without tourniquet,and tendon“Z”lengthening was started 20 to 30 minutes later.The brace was fixed after operation,and the score was based on total active motion(TAM)standard.Results All the 9 patients were follow-up for 6 to 20 months,with an average of 12 months.The patients recovered well after operation.According to TAM score,the average excellent and good rate was 100%.ConclusionThe WALANT anesthesia combined with tendon“Z”lengthening has a clear clinical efficacy on the late mild forearm ischemic muscle contracture with finger flexion deformity,and the risk of bleeding is low.The hand activities can be observed at any time during the operation,which has a good therapeutic effect and is worthy of clinical attention.