超声引导血肿阻滞联合近端骨膜神经阻滞在桡骨远端骨折急诊无痛复位中的临床疗效观察

The Clinical Efficacy of Ultrasound-Guided Hematoma Block Combined with Proximal Periosteal Nerve Block in the Emergency Painless Reduction of Distal Radius Fractures

目的:研究超声引导血肿阻滞联合近端骨膜神经阻滞在桡骨远端骨折急诊无痛复位中的临床疗效。方法:纳入2022年09月~2023年12月就诊于福建中医药大学附属第二人民医院急诊外科、急诊骨科的60例桡骨远端骨折病人分为两组,其中观察组使用骨折断端血肿阻滞手法复位,实验组使用超声引导血肿阻滞联合近端骨膜神经阻滞手法复位。记录围复位期间情况比较2组麻醉操作时间、麻醉前后疼痛VAS评分、复位失败转手术率,复位8周后使用Gartland和Werley腕关节评分评估腕关节恢复情况。结果:观察组剔除病例1例,因随访丢失退出。两组基线数据均无统计差异(p > 0.05),实验组VAS评分麻醉前8.00 (7.00, 9.00),麻醉后2.00 (2.00, 2.00),石膏固定后1.00 (0.00, 1.00)。观察组VAS评分麻醉前8.00 (7.75, 9.00),麻醉后3.00 (2.00, 4.00),石膏固定后1.00 (1.00, 2.00)。实验组在各时间点VAS评分均低于对照组(p 0.05)。结论:超声引导下桡骨远端骨折血肿阻滞和桡骨骨膜阻滞能够在复位过程中提供良好的镇痛效果,特别是对于骨折断端定位困难的患者,同时实时床旁超声引导有助于实时提供初次复位及调整复位时图像提高复位质量。

Objective: To study the clinical efficacy of ultrasound-guided hematoma block combined with proximal periosteal nerve block in emergency painless reduction of distal radius fractures. Methods: From September 2022 to December 2023, 60 patients with distal radius fractures who were treated in the emergency surgery and emergency orthopedics department of the Second People’s Hospital Affiliated to Fujian University of Traditional Chinese Medicine were divided into two groups. The observation group was treated with fracture end hematoma block manual reduction, and the experimental group was treated with ultrasound-guided hematoma block combined with proximal periosteal nerve block manual reduction. The anesthesia operation time, pain VAS score before and after anesthesia, and the rate of conversion to surgery after reduction failure were compared between the two groups. After 8 weeks of reduction, Gartland and Werley wrist scores were used to evaluate the recovery of wrist joint. Results: One case was excluded from the observation group and withdrew due to loss of follow-up. There was no statistical difference in baseline data between the two groups (p > 0.05). The VAS score of the experimental group was 8.00 (7.00, 9.00) before anesthesia, 2.00 (2.00, 2.00) after anesthesia, and 1.00 (0.00, 1.00) after plaster fixation. The VAS score of the observation group was 8.00 (7.75, 9.00) before anesthesia, 3.00 (2.00, 4.00) after anesthesia, and 1.00 (1.00, 2.00) after plaster fixation. The VAS scores of the experimental group were lower than those of the control group at each time point (p 0.05). Conclusion: Ultrasound-guided hematoma block and radial periosteal block for distal radius fracture can provide good analgesic effect during reduction, especially for patients with difficult positioning of fracture ends. At the same time, real-time bedside ultrasound guidance is helpful to provide real-time initial reduction and adjust the image during reduction to improve the quality of reduction.