局部麻醉手外科及淺表軟組織中應用廣泛，但在骨折內(nèi)固定使用中應用較少。
為探討局部麻醉在踝關節(jié)骨折切開復位中的應用，果然學者對此進行了研究，該結(jié)果發(fā)表在2021.03 JBJS期刊上。
Background
無止血帶清醒下局部麻醉(WALANT)是一種簡單的技術(shù)，已成功應用于手外科手術(shù)。當WALANT技術(shù)用于橈骨遠端骨折的鋼板內(nèi)固定治療，已被證明是骨創(chuàng)傷的一種經(jīng)濟有效的方法。本研究的目的是評估WALANT技術(shù)在踝關節(jié)骨折切開復位內(nèi)固定中的適用性。
（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。骨折根據(jù)OTA/OA分型標準進行分類。不包括Maisonneuve骨折、距骨骨折或后踝骨折的患者。記錄損傷機制、骨折類型、合并癥和并發(fā)癥。使用0.9%生理鹽水溶液、2%利多卡因與1:1000,000腎上腺素的溶液滲透手術(shù)部位以實現(xiàn)局部麻醉。在骨折愈合后，使用AOFAS評分評估功能結(jié)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.）
圖1：血腫麻醉示意圖
圖2：內(nèi)踝皮下浸潤麻醉
圖3：外踝皮下浸潤麻醉
圖4：術(shù)中手術(shù)圖
圖5：鉆孔前的骨膜麻醉示意圖
圖6：骨膜麻醉局部放大圖
圖7：鋼板置入后圖示
Results
男性39例(67%)，女性19例(33%)，平均年齡46.79±8.54歲。根據(jù)OTA/AO分類，36例骨折(62%)為44-C2，11例骨折(19%)為44-B2，7例骨折(12%)為44-C1，4例骨折(7%)為44-B1。平均失血量為29.40±7.38毫升，平均手術(shù)時間為59.72±7.19分鐘，平均術(shù)中疼痛視覺模擬評分為1.24±0.43(范圍0-3)。平均愈合時間為16.21±3.52周，平均AOFAS踝-后足評分為86.38±5.72。3名患者(5.2%)出現(xiàn)骨折部位不愈合，2名患者出現(xiàn)手術(shù)部位感染，1名依從性差的糖尿病患者出現(xiàn)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.）
圖8：術(shù)后結(jié)果
Conclusion
WALANT技術(shù)是一種安全的踝關節(jié)骨折固定技術(shù)，已被證明可用于足部和踝關節(jié)手術(shù)，特別是在資源有限的環(huán)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.）
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