踝关节骨折局麻开？对的，你没看错！

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前言：

      踝关节骨折通常采用全身麻醉或椎管麻醉，局部麻醉在手外科及浅表组织手术中运用较多，在踝关节骨折ORIF中的应用未见报道。

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参考文献：Tahir M, Chaudhry EA, Ahmed N, Mamoon AH, Ahmad M, Jamali AR, Mehboob G. Ankle Fracture Fixation with Use of WALANT (Wide Awake Local Anesthesia with No Tourniquet) Technique: An Attractive Alternative for the Austere Environment. J Bone Joint Surg Am. 2021 Mar 3;103(5):397-404. 

局部麻醉手外科及浅表软组织中应用广泛，但在骨折内固定使用中应用较少。

为探讨局部麻醉在踝关节骨折切开复位中的应用，果然学者对此进行了研究，该结果发表在2021.03 JBJS期刊上。

Background

无止血带清醒下局部麻醉(WALANT)是一种简单的技术，已成功应用于手外科手术。当WALANT技术用于桡骨远端骨折的钢板内固定治疗，已被证明是骨创伤的一种经济有效的方法。本研究的目的是评估WALANT技术在踝关节骨折切开复位内固定中的适用性。 

（Wide awake local anesthesia with no tourniquet (WALANT) is a simple technique that has had successful application in hand surgery. When utilized in the plating of distal radial fractures, the WALANT technique has proven to be a cost-effective approach in orthopaedic trauma. The aim of the present study was to assess the applicability of the WALANT technique in open reduction and internal fixation of ankle fractures.）

Methods

自2016年10月至2018年9月招募了58名患者。骨折根据OTA/OA分型标准进行分类。不包括Maisonneuve骨折、距骨骨折或后踝骨折的患者。记录损伤机制、骨折类型、合并症和并发症。使用0.9%生理盐水溶液、2%利多卡因与1:1000,000肾上腺素的溶液渗透手术部位以实现局部麻醉。在骨折愈合后，使用AOFAS评分评估功能结果 。

（Fifty-eight patients were recruited from October 2016 to September 2018. Fractures were categorized according to the OTA/AO classification. We did not include patients with Maisonneuve, talar, or posterior malleolar fractures. Mechanism of injury, fracture type, comorbidities, and complications were recorded. The surgical site was infiltrated to achieve local anesthesia using a solution of 0.9% normal saline solution and 2% lidocaine with 1:1,000,000 epinephrine. Functional outcomes were assessed at the time of fracture union with use of the American Orthopaedic Foot & Ankle Society (AOFAS) Ankle-Hindfoot Scale.）

图1：血肿麻醉示意图

图2：内踝皮下浸润麻醉

图3：外踝皮下浸润麻醉

图4：术中手术图

图5：钻孔前的骨膜麻醉示意图

图6：骨膜麻醉局部放大图

图7：钢板置入后图示

Results

男性39例(67%)，女性19例(33%)，平均年龄46.79±8.54岁。根据OTA/AO分类，36例骨折(62%)为44-C2，11例骨折(19%)为44-B2，7例骨折(12%)为44-C1，4例骨折(7%)为44-B1。平均失血量为29.40±7.38毫升，平均手术时间为59.72±7.19分钟，平均术中疼痛视觉模拟评分为1.24±0.43(范围0-3)。平均愈合时间为16.21±3.52周，平均AOFAS踝-后足评分为86.38±5.72。3名患者(5.2%)出现骨折部位不愈合，2名患者出现手术部位感染，1名依从性差的糖尿病患者出现骨髓炎。

（Thirty-nine patients (67%) were male and 19 (33%) were female, and the mean age was 46.79 ± 8.54 years. According to the OTA/AO classification, 36 fractures (62%) were 44C2, 11 (19%) were 44B2, 7 (12%) were 44C1, and 4 (7%) were 44B1 fractures. Average blood loss was 29.40 ± 7.38 mL, the mean operative time was 59.72 ± 7.19 minutes, and the mean intraoperative visual analogue scale (VAS) for pain was 1.24 ± 0.43 (range, 0 to 3). The mean time to union was 16.21± 3.52 weeks, with a mean AOFAS Ankle-Hindfoot Scale score of 86.38 ± 5.72. Three patients (5.2%) developed nonunion of a fracture site, 2 patients had a surgical site infection, and 1 noncompliant diabetic patient developed osteomyelitis.）

图8：术后结果

Conclusion

WALANT技术是一种安全的踝关节骨折固定技术，已被证明可用于足部和踝关节手术，特别是在资源有限的环境中。

（The WALANT technique is a safe technique for ankle fracture fixation and has been shown to be useful in foot and ankle surgery, particularly in limited-resource environments.）

仅做学术交流使用，谢绝转载，侵权联系后删除

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