目的: 分析非麻醉状态下闭合复位与腋路臂丛神经阻滞下闭合复位对桡骨远端骨折患者效果情况对比。方法: 选取2021年5月-2023年5月北京积水潭医院贵州医院行桡骨远端骨折治疗的0~16岁患者88例,按照随机数字表法分为对照组44例,实验组44例。对照组行非麻醉状态下闭合复位,实验组行腋路臂丛神经阻滞下闭合复位。检测平均动脉压(mean artery pressure, MAP)、平均心率、平均呼吸情况;记录患者复位前后腕关节活动度;采用视觉模拟评分法(visual analogue scale, VAS)对患者自身疼痛程度进行评估;记录复位成功率和两组并发症发生率。结果: 复位后,实验组MAP、平均心率、平均呼吸水平低于对照组(P＜0.05);桡偏度、掌曲度、旋前度、旋后度水平情况高于对照组(P＜0.05)。术后即刻、12 h、24 h、48 h实验组VAS评分水平均低于对照组(P＜0.05)。实验组复位成功率高于对照组(P＜0.05)。实验组总并发症发生率稍高于对照组(P＞0.05)。结论: 与非麻醉状态下闭合复位比较,腋路臂丛神经阻滞下闭合复位可降低儿童桡骨远端骨折患者血压、心率、呼吸、疼痛情况,改善腕关节功能,提高复位成功率,且安全性较高。
Objective: To compare the effects of closed reduction under non-anesthesia and axillary brachial plexus block on patients with distal radius fractures. Methods: From May 2021 to May 2023, 88 patients aged 0~16 years old who underwent distal radius fracture treatment in Beijing Jishuitan Hospital Guizhou Hospital were selected and randomly divided into control group (44 patients) and experimental group (44 patients). The control group underwent closed reduction under non-anesthesia, the experimental group underwent closed reduction under axillary brachial plexus block. Mean artery pressure (MAP), mean heart rate and mean respiration were measured. The wrist joint activity before and after reduction was recorded. Visual Analogue Scale (VAS) was used to evaluate the degree of patients' own pain. The success rate of reduction and the incidence of complications in the two groups were recorded. Results: After reduction, the MAP, mean heart rate and mean respiration level in the experimental group were lower than those in the control group (P＜0.05). The levels of radial bias angle, palm curvature, pronation and supination in the experimental group were higher than those in the control group (P＜0.05). The VAS score level at the immediate, 12 h, 24 h and 48 h postoperative period in the experimental group was lower than that in the control group (P＜0.05). The reduction success rate in the experimental group was higher than that in the control group (P＜0.05). The overall complication rate was slightly higher in the experimental group than that in the control group (P＞0.05). Conclusion: Compared with closed reduction under non-anesthetic state, closed reduction under axillary brachial plexus block can reduce blood pressure, heart rate, respiration and pain in children with distal radius fracture, improve their wrist function and success rate of reduction, with high safety.
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