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

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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

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

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