Objective:
To discuss the method and effectiveness of Wide-awake technique in flexor tendon tenolysis.

Methods:
The clinical data of 16 patients (22 fingers) with flexor tendon adhesion treated by Wide-awake technique for flexor tendon tenolysis between May 2019 and December 2019 were retrospectively analyzed. The patients were all male, aged from 18 to 55 years old, with an average of 35 years old. Among them, 4 cases (7 fingers) after replantation of severed fingers, 4 cases (7 fingers) after flexor tendon rupture repair, and 8 cases (8 fingers) after open reduction and internal fixation of proximal fractures. The time from the original operation to this operation was 6-18 months, with an average of 8 months. The visual analogue scale (VAS) score was used to evaluate the patient's pain during local anesthesia (when the first needle penetrated the skin), intraoperative, and 24 hours postoperatively; and the recovery of finger movement was evaluated by total finger joint active range of motion (TAM) evaluation system and Strickland (1980) standard after operation.

Results:
Intraoperative hemostasis and anesthesia were satisfactory, and the patient could fully cooperate with the surgeon in active finger movements. There were different degrees of pain during local anesthesia (VAS score was 2-4), no pain during operation (VAS score was 0), and different degrees of pain after operation (VAS score was 1-8, 9 patients needed analgesics). All incisions healed by first intention after operation. All 16 cases were followed up 9-15 months with an average of 12 months. Finger function was significantly improved, no tendon rupture occurred. At last follow-up, the patients after proximal fracture open reduction and internal fixation were rated as excellent in 4 fingers and good in 4 fingers according to the TAM standard, and both were excellent according to the Strickland (1980) standard; and the patients after replantation of severed fingers and flexor tendon rupture repair were rated as excellent in 4 fingers and good in 10 fingers according to TAM standard, and as excellent in 6 fingers and good in 8 fingers according to Strickland (1980) standard.

Conclusion:
Wide-awake technique applied in flexor tendon tenolysis can accurately judge the tendon adhesion and release degree through the patient's active activity, achieve the purpose of complete release, and the effectiveness is satisfactory; the effectiveness of tendon adhesion release surgery after fracture internal fixation is better than that of patients after tendon rupture suture and replantation.

目的:
介绍完全清醒(Wide-awake)技术应用于屈肌腱松解术的方法及治疗效果。.

方法:
回顾分析 2019 年 5 月—12 月运用 Wide-awake 技术行屈肌腱松解术治疗的 16 例(22 指)屈肌腱粘连患者临床资料。患者均为男性,年龄 18~55 岁,平均 35 岁。其中断指再植术 4 例(7 指),屈肌腱断裂修复术 4 例(7 指),近节骨折切开复位内固定术 8 例(8 指)。原始手术至该次手术时间为 6~18 个月,平均 8 个月。分别于局麻操作时(第 1 针刺入皮肤时)、术中及术后 24 h,采用疼痛视觉模拟评分(VAS)评价患者疼痛情况;术后采用总指关节主动活动度(TAM)及 Strickland(1980)标准评定手指活动恢复情况。.

结果:
术中止血效果及麻醉效果均满意,患者能完全配合术者进行手指主动活动。局麻操作时有不同程度疼痛感(VAS 评分 2~4 分),术中无疼痛(VAS 评分 0 分),术后有不同程度疼痛(VAS 评分 1~8 分,9 例患者需要服用止痛药物)。术后患者切口均Ⅰ期愈合。16 例均获随访,随访时间 9~15 个月,平均 12 个月。手指活动功能均有明显改善,无肌腱再断裂发生。末次随访时近节骨折切开复位内固定术后患者按 TAM 标准评定为优 4 指、良 4 指,按 Strickland(1980)标准评定均为优;断指再植术及屈肌腱断裂修复术后患者按 TAM 标准评定为优 4 指、良 10 指,按 Strickland(1980)标准评定为优 6 指、良 8 指。.

结论:
Wide-awake 技术应用于屈肌腱松解手术,术中通过患者主动活动,可准确判断肌腱粘连情况及松解程度,达到彻底松解的目的,治疗效果满意;骨折内固定术后肌腱粘连松解手术效果优于肌腱断裂缝合和断指再植术后患者。.





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