两种固定方法对创伤性尺桡骨骨折术后恢复并发症及成本-效用的影响

doi:10.3969/j.issn.1006-6233.2024.06.030

摘要
图/表
参考文献
相关文章 (2)

全文: PDF (1206 KB) HTML (1 KB)
输出: BibTeX | EndNote (RIS)

摘要 目的: 通过术后恢复、并发症及成本-效用探究交锁髓内钉与钢板治疗创伤性尺桡骨骨折的应用价值。方法: 选择2021年4月至2023年3月我院创伤性尺桡骨骨折患者92例,随机数字表法分为钢板组、髓内钉组,各46例。髓内钉组采用交锁髓内钉内固定术,钢板组采用钢板内固定术。观察两组手术一般情况、骨折愈合进程、围手术疼痛程度,并于术前、术后6h、72h采用酶联免疫法检测炎症应激[C反应蛋白(CRP)、白细胞介素(IL-1β、IL-18)、肿瘤坏死因子-α(TNF-α)]、术后6个月采用Flynn功能恢复评分标准评估功能优良率、并发症及成本-效用。结果: 髓内钉组手术时间、切口长度、住院时间分别为(74.85±12.47)min、(5.02±1.53)cm、(8.60±2.77)d,均短于钢板组的(86.18±14.00)min、(9.77±1.94)cm、(14.18±4.00)d,失血量、引流量分别为(38.59±10.14)mL、(90.03±20.63)mL,均低于钢板组的(120.83±15.67)mL、(151.66±17.94)mL;髓内钉组骨折愈合时间、完全持重时间分别为(8.56±1.49)周、(11.29±3.44)周,均早于(10.08±1.95)周、(13.58±4.36)周,术后6个月骨折端骨密度比率为(0.89±0.06),高于钢板组(0.86±0.05)(t=4.201、2.797、2.605,P=0.000、0.006、0.011);髓内钉组术后6h、12h、48h、72h疼痛VAS评分分别为(3.26±0.84)分、(2.87±0.75)分、(2.50±0.69)分、(2.48±0.51)分,低于钢板组的(4.00±0.59)分、(3.74±0.66)分、(3.52±0.70)分、(3.36±0.64)分;髓内钉组术后6h、72h的CRP分别为(15.11±6.00)mg/L,(8.53±1.76)mg/L,低于钢板组的(18.42±7.03)mg/L,(11.40±2.83)mg/L,IL-1β分别为(101.60±30.51)pg/mL,(19.10±5.96)pg/mL,低于钢板组的(140.78±34.19)pg/mL,(24.85±8.74)pg/mL,IL-18分别为(32.00±9.57)pg/mL,(18.04±5.66)pg/mL,低于钢板组的(39.56±11.24)pg/mL,(27.11±7.25)pg/mL,TNF-α分别为(29.42±8.33)pg/mL,(9.05±2.18)pg/mL,低于钢板组的(37.02±10.51)pg/mL,(13.74±3.59)pg/mL;两组功能优良率比较无显著差异(P>0.05);髓内钉组成本-效用优于钢板组。结论: 交锁髓内钉用于创伤性尺桡骨骨折患者,可优化手术操作,减少术中出血,减轻围术期疼痛,促进术后恢复,减轻患者经济负担,且有较好的远期效果及安全性。

	服务

	把本文推荐给朋友
	加入我的书架
	加入引用管理器
	E-mail Alert
	RSS
	作者相关文章

关键词 ：尺桡骨骨折, 钢板内固定术, 交锁髓内钉内固定术, 炎症应激, 疼痛程度

Abstract：Objective: To explore the application value of intramedullary nailing and plate fixation in the treatment of traumatic distal radius and ulna fractures through postoperative recovery, complications, and cost-effectiveness.Methods: Ninety-two patients with traumatic distal radius and ulna fractures treated in our hospital from April 2021 to March 2023 were randomly divided into two groups: the intramedullary nailing group (n=46) and the plate group (n=46). The intramedullary nailing group underwent internal fixation with interlocking intramedullary nails, while the plate group underwent internal fixation with plates. General conditions of the two groups, fracture healing process, perioperative pain level, and inflammatory stress [C-reactive protein (CRP), interleukin (IL-1β, IL-18), tumor necrosis factor-alpha (TNF-α)] were observed. Functional recovery rate, complications, and cost-effectiveness were assessed using Flynn's functional recovery scoring criteria at 6 months postoperatively.Results: The intramedullary nailing group had shorter operation time, incision length, and hospital stay [(74.85±12.47) min, (5.02±1.53) cm, (8.60±2.77) d] compared to the plate group [(86.18±14.00) min, (9.77±1.94) cm, (14.18±4.00) d]. The blood loss and drainage volume [(38.59±10.14) ml, (90.03±20.63) ml] were lower than those in the plate group [(120.83±15.67) ml, (151.66±17.94) ml] . The intramedullary nailing group had earlier fracture healing time and full weight-bearing time [(8.56±1.49) weeks, (11.29±3.44) weeks] compared to the plate group [(10.08±1.95) weeks, (13.58±4.36) weeks]. The bone density ratio at the fracture end at 6 months postoperatively was higher in the intramedullary nailing group (0.89±0.06) than in the plate group (0.86±0.05). The VAS pain scores at 6 h, 12 h, 48 h, and 72 h postoperatively were lower in the intramedullary nailing group [(3.26±0.84), (2.87±0.75), (2.50±0.69), (2.48±0.51)] compared to the plate group [(4.00±0.59), (3.74±0.66), (3.52±0.70), (3.36±0.64)] . The CRP levels at 6 h and 72 h postoperatively were lower in the intramedullary nailing group [(15.11±6.00) mg/L, (8.53±1.76) mg/L] compared to the plate group [(18.42±7.03) mg/L, (11.40±2.83) mg/L]. IL-1β, IL-18, and TNF-α levels were also lower in the intramedullary nailing group compared to the plate group (all P<0.05). There was no significant difference in the functional recovery rate between the two groups (P>0.05). The cost-effectiveness of intramedullary nailing was superior to plate fixation.Conclusion: Intramedullary nailing for traumatic distal radius and ulna fractures can optimize surgical procedures, reduce intraoperative bleeding, alleviate perioperative pain, promote postoperative recovery, alleviate patient financial burden, and has good long-term efficacy and safety.

Key words： Distal radius and ulna fractures Plate fixation Interlocking intramedullary nail fixation Inflammatory stress Pain level

基金资助:山东省优秀中青年科学家科研奖励基金,(编号:BS2018SW412)

通讯作者: 董雨青

引用本文:

沈林华, 蔡程名, 高尚, 董雨青. 两种固定方法对创伤性尺桡骨骨折术后恢复并发症及成本-效用的影响[J]. 河北医学, 2024, 30(6): 1035-1040.
SHEN Linhua. The Impact of Two Fixation Methods on Postoperative Recovery Complications and Cost-effectiveness of Traumatic Distal Radius and Ulna Fractures. HeBei Med, 2024, 30(6): 1035-1040.

链接本文:

http://www.hbyxzzs.cn/CN/10.3969/j.issn.1006-6233.2024.06.030 或 http://www.hbyxzzs.cn/CN/Y2024/V30/I6/1035

[1] Wang ZH,Li KN,Lan H,et al.A Comparative study of intramedullary nail strengthened with auxiliary locking plate or steel wire in the treatment of unstable trochanteric fracture of femur[J].Orthop Surg,2020,12(1):108-115.
[2] Maleki M,Tehrani AF,Aray A,et al.Intramedullary nail holes laser indicator,a non-invasive technique for interlocking of intramedullary nails[J].Sci Rep,2021,11(1):21166.
[3] 李伟,吴声忠,黄华,等.健骨复元汤治疗小儿尺桡骨闭合性骨折的疗效及对患儿炎症因子和骨代谢指标的影响[J].河北中医,2021,43(7):1087-1091.
[4] Shafshak TS,Elnemr R.The visual analogue scale versus numerical rating scale in measuring pain severity and predicting disability in low back pain[J].Clin Rheumatol,2021,27(7):282-285.
[5] Dejardin LM,Perry KL,von Pfeil DJF,et al.Interlocking nails and minimally invasive osteosynthesis[J].Vet Clin North Am Small Anim Pract,2020,50(1):67-100.
[6] Wu WY,Zhao ZH,Wang YQ,et al.Clinical observation and finite element analysis of femoral stable interlocking intramedullary nail in intertrochanteric fractures[J].Int Orthop,2023,47(9):2319-2326.
[7] 胡松,高大新,游红林,等.交锁髓内钉内固定术对创伤性下肢长管状骨骨折愈合的影响[J].中国临床保健杂志,2021,24(4):558-561.
[8] Wahl EP,Lampley AJ,Chen A,et al.Inflammatory cytokines and matrix metalloproteinases in the synovial fluid after intra-articular elbow fracture[J].Shoulder Elbow Surg,2020,29(4):736-742.
[9] Pham TM,Erichsen JL,Kowal JM,et al.Elevation of pro-inflammatory cytokine levels following intra-articular fractures-A systematic review[J].Cells,2021,10(4):902.
[10] Yin CY,Liu BY,Wang P,et al.Eucalyptol alleviates inflammation and pain responses in a mouse model of gout arthritis[J].Br Pharmacol,2020,177(9):2042-2057.
[11] Van der Vlist M,Raoof R,Willemen HLDM,et al.Macrophages transfer mitochondria to sensory neurons to resolve inflammatory pain[J].Neuron,2022,110(4):613-626.