| 保留主动屈伸指活动的选择性神经阻滞在手指狭窄性腱鞘炎的应用 |
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Received:September 18, 2023
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| 作者 | Author | 单位 | Unit | E-Mail |
| 王丽 |
WANG Li |
遂宁市中心医院麻醉科, 四川 遂宁 629000 |
Department of Anesthesiology, Suining Central Hospi- tal, Suining 629000, Sichuan, China |
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| 余晓军 |
YU Xiao-jun |
遂宁市中心医院骨科中心一病区, 四川 遂宁 629000 |
Ward One, Orthopaedic Center, Suining Central Hospital, Suining 629000, Sichuan, China |
yuxiaojun2024@163.com |
| 杨帆 |
YANG Fan |
遂宁市中心医院麻醉科, 四川 遂宁 629000 |
Department of Anesthesiology, Suining Central Hospi- tal, Suining 629000, Sichuan, China |
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| 黎娟 |
LI Juan |
遂宁市中心医院麻醉科, 四川 遂宁 629000 |
Department of Anesthesiology, Suining Central Hospi- tal, Suining 629000, Sichuan, China |
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| 王志强 |
WANG Zhi-qiang |
遂宁市中心医院骨科中心一病区, 四川 遂宁 629000 |
Ward One, Orthopaedic Center, Suining Central Hospital, Suining 629000, Sichuan, China |
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| 期刊信息：《中国骨伤》2025年38卷，第4期，第411-414页 |
| DOI：10.12200/j.issn.1003-0034.20230317 |
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目的: 探讨前臂远1/3段超声引导下、保留主动屈伸指活动的选择性神经阻滞麻醉在手指狭窄性腱鞘炎应用效果。
方法: 回顾性分析2017年1月至2022年1月期间61例手指狭窄性腱鞘炎手术患者,美国麻醉医师协会(American Society of Anesthesiologists,ASA)分级Ⅰ级41例,Ⅱ级20例;男15例,女46例;年龄16~72岁;体质量44~75 kg。根据病变部位,在超声引导下前臂中远1/3平面对正中神经与尺神经及腕关节桡背侧对桡神经浅支采用0.5%罗哌卡因选择性进行阻滞麻醉。分别记录每种神经麻醉药用量,麻醉后每30 s针刺法检测各神经阻滞效果,记录起效时间及起效后手指主动屈伸活动情况。术后1、3、6个月通过门诊或电话随访了解松解疗效。
结果: 麻醉阻滞效果,优60例,良1例。1例单纯中指狭窄性腱鞘炎患者手术时有轻微疼痛,给予腕部桡神经浅支阻滞后疼痛感消失。共阻滞桡神经浅支20例,单次用药(1.7±0.3) ml,开始起效时间(0.6±0.2) min;正中神经45例,单次用药(4.1±1.0) ml,开始起效时间(1.2±0.3) min;尺神经16例,单次用药(3.9±0.5) ml,开始起效时间(1.7±0.3) min。所有患者能主动屈伸手指。61例术后均获得随访,时间6~10(8.0±2.0)个月,均无复发。
结论: 前臂远1/3段超声引导下选择性神经阻滞能为手指狭窄性腱鞘炎患者获得安全快速有效的麻醉效果,且保留了主动活动功能,利于判断松解程度,提高了手术疗效。 |
| [关键词]:超声引导 前臂 阻滞 狭窄性腱鞘炎 |
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| Application of selective nerve block maintaining active finger flexion and extension in the treatment of stenosing tenosynovitis of fingers |
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Abstract:
Objective To explore the efficacy of ultrasound guided selective nerve block anesthesia in the distal third of the forearm while maintaining active flexion and extension during surgery for stenosing tenosynovitis.
Methods A retrospective analysis was conducted on 61 patients including 15 males and 46 females with American Society of Anesthesiologists (ASA) gradesⅠorⅡ,who underwent surgery for stenosing tenosynovitis in our hospital between January 2017 and January 2022. These patients,aged from 16 to 72 years old (weighing 44 to 75 kg),underwent selective nerve blocks targeting the median and ulnar nerves at the middle and distal third of the forearm,and the superficial branch of radial nerve at the dorsal radial side of wrist joint,under ultrasound guidance. A 0.5% ropivacaine solution was used for each nerve block. The anesthetic dosage for each nerve was recorded,and the efficay of each nerve block was monitored by acupuncture every 30 seconds post administration. The onset time and ability to perform active finger flexion and extension were recorded. Outpatient or telephone follow up was performed 1,3 and 6 months postoperatively to evaluate the efficacy of release.
Results The efficacy of anesthesia block was excellent in 60 patients and good in 1 patient. One patient with simple stenosing tenosynovitis of the middle finger reported slight pain intraoperatively,which resolved with additional block of superficial branch of radial nerve of the wrist. Superficial branch of radial nerve was blocked in 20 patients,with a single dose of (1.7±0.3) ml and the onset time of (0.6±0.2) min. Median nerve was blocked in 45 patients,with a single dose of (4.1±1.0) ml and the onset time of (1.2±0.3) min;Ulnar nerve was blocked in 16 patients,with a single dose of (3.9±0.5) ml and the onset time of (1.7±0.3) min. All the patients retained active flexion and extension of the fingers. All 61 patients were followed up for 6 to 10 months with an average of (8.0±2.0) months, and no recurrence was observed.
Conclusion Ultrasound guided selective nerve block of distal third of the forearm can provide safe,rapid and good anesthesia for patients undergoing surgery for stenosing tenosynovitis of fingers,while maintaining the active finger movement. This technique facilitates intraoperative assessment of release and improves overall surgical outcomes. |
| KEYWORDS:Ultrasound guidance Forearm Block Stenosing tenosynovitis |
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| 引用本文，请按以下格式著录参考文献： |
| 中文格式: | 王丽,余晓军,杨帆,黎娟,王志强.保留主动屈伸指活动的选择性神经阻滞在手指狭窄性腱鞘炎的应用[J].中国骨伤,2025,38(4):411~414 |
| 英文格式: | WANG Li,YU Xiao-jun,YANG Fan,LI Juan,WANG Zhi-qiang.Application of selective nerve block maintaining active finger flexion and extension in the treatment of stenosing tenosynovitis of fingers[J].zhongguo gu shang / China J Orthop Trauma ,2025,38(4):411~414 |
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