AIM: To assess the clinical effects and the morphological grade of nerve compression.METHODS: In a prospective single-center randomized, open study we assessed the clinical effects and the morphological grade of nerve...AIM: To assess the clinical effects and the morphological grade of nerve compression.METHODS: In a prospective single-center randomized, open study we assessed the clinical effects and the morphological grade of nerve compression during 20 min of either a silicon ring(group A) or pneumatic tourniquet(group B) placement variantly on the upper non-dominant limb in 14 healthy human volunteers. Before and during compression, the median and radial nerves were visualized in both groups by 3 Tesla MR imaging, using high resolutional(2.5 mm slice thickness) axial T2-weighted sequences. RESULTS: In group A, Visual analog pain scale was 5.4 ± 2.2 compared to results of group B, 2.9 ± 2.5, showing a significant difference(P = 0.028). FPS levels in group A were 2.6 ± 0.9 compared to levels in group B 1.6 ± 1, showing a significant difference(P = 0.039). Results related to measureable effect on median and radial nerve function were equal in both groups. No undue pressure signs on the skin, redness or nerve damage occurred in either group. There was no significant difference in the diameters of the nerves without and under compression in either group on T2 weighted images.CONCLUSION: Based on our results, no differences between narrow and wide tourniquets were identified. Silicon ring tourniquets can be regarded as safe for short time application.展开更多
目的介绍完全清醒无止血带局部麻醉(wide awake local anesthesia no tourniquet,WALANT)技术在手部狭窄性腱鞘炎手术中的应用,并探讨其治疗效果。方法2018年6月-2020年6月,对20例手部狭窄性腱鞘炎患者采用WALANT技术行腱鞘切开手术,采...目的介绍完全清醒无止血带局部麻醉(wide awake local anesthesia no tourniquet,WALANT)技术在手部狭窄性腱鞘炎手术中的应用,并探讨其治疗效果。方法2018年6月-2020年6月,对20例手部狭窄性腱鞘炎患者采用WALANT技术行腱鞘切开手术,采用视觉模拟评分法(VAS)对术前、术中及术后术区疼痛进行评估,术中评估出血量及手指主动活动情况,术后观察术区皮肤血供及麻醉不良反应。结果术中止血效果满意,不影响运动功能。局部麻醉操作时会有不同程度的疼痛感(VAS评分2~3分),术中无疼痛(VAS评分0分),术后有不同程度的疼痛(VAS评分1~2分)。术后术区皮肤均一期愈合,无麻醉不良反应。20例均获得随访,时间3~6个月,平均4.5个月,未见腱鞘炎复发。结论WALANT技术应用于手部狭窄性腱鞘炎手术安全有效,在起到良好的止血效果同时,患者完全清醒,无疼痛,无需止血带,患者可以随时主动活动手指,操作简单,有利于手外科日间手术的开展。展开更多
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...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。展开更多
基金Volunteers honorary in the amount of 3.000 USD was supported by private funds of Kovar FMHemaClear~(TM) devices were provided by OHK Medical Device,Haifa,Israel
文摘AIM: To assess the clinical effects and the morphological grade of nerve compression.METHODS: In a prospective single-center randomized, open study we assessed the clinical effects and the morphological grade of nerve compression during 20 min of either a silicon ring(group A) or pneumatic tourniquet(group B) placement variantly on the upper non-dominant limb in 14 healthy human volunteers. Before and during compression, the median and radial nerves were visualized in both groups by 3 Tesla MR imaging, using high resolutional(2.5 mm slice thickness) axial T2-weighted sequences. RESULTS: In group A, Visual analog pain scale was 5.4 ± 2.2 compared to results of group B, 2.9 ± 2.5, showing a significant difference(P = 0.028). FPS levels in group A were 2.6 ± 0.9 compared to levels in group B 1.6 ± 1, showing a significant difference(P = 0.039). Results related to measureable effect on median and radial nerve function were equal in both groups. No undue pressure signs on the skin, redness or nerve damage occurred in either group. There was no significant difference in the diameters of the nerves without and under compression in either group on T2 weighted images.CONCLUSION: Based on our results, no differences between narrow and wide tourniquets were identified. Silicon ring tourniquets can be regarded as safe for short time application.
文摘目的介绍完全清醒无止血带局部麻醉(wide awake local anesthesia no tourniquet,WALANT)技术在手部狭窄性腱鞘炎手术中的应用,并探讨其治疗效果。方法2018年6月-2020年6月,对20例手部狭窄性腱鞘炎患者采用WALANT技术行腱鞘切开手术,采用视觉模拟评分法(VAS)对术前、术中及术后术区疼痛进行评估,术中评估出血量及手指主动活动情况,术后观察术区皮肤血供及麻醉不良反应。结果术中止血效果满意,不影响运动功能。局部麻醉操作时会有不同程度的疼痛感(VAS评分2~3分),术中无疼痛(VAS评分0分),术后有不同程度的疼痛(VAS评分1~2分)。术后术区皮肤均一期愈合,无麻醉不良反应。20例均获得随访,时间3~6个月,平均4.5个月,未见腱鞘炎复发。结论WALANT技术应用于手部狭窄性腱鞘炎手术安全有效,在起到良好的止血效果同时,患者完全清醒,无疼痛,无需止血带,患者可以随时主动活动手指,操作简单,有利于手外科日间手术的开展。
文摘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。
