摘要
目的:比较掌侧入路、背侧入路微创加压螺钉固定术治疗腕舟骨骨折的疗效,以及分别对血清创伤应激指标和疼痛介质的影响。方法:本研究为回顾性研究,临床资料来源于2018年1月~2021年1月来我院接受治疗的88例腕舟骨骨折患者,根据入路方式的不同分为A组(背侧入路,43例)和B组(掌侧入路,45例)。观察两组患者腕功能优良率、围术期相关指标、视觉疼痛模拟评分(VAS)、腕关节活动度、血清创伤应激指标、疼痛介质情况。结果:两组优良率组间对比未见明显差异(P>0.05)。B组术中出血量少于A组,骨性愈合时间短于A组(P<0.05),两组手术时间对比无差异(P>0.05)。B组术后6个月VAS评分低于A组(P<0.05)。两组术后1年腕关节掌屈、背伸、桡偏、尺偏活动度均增大(P<0.05)。两组术后3 d皮质醇(Cor)、C反应蛋白(CRP)、促肾上腺皮质激素(ACTH)均升高,但B组低于A组(P<0.05)。两组术后3 d、前列腺素E2(PGE2)、P物质(SP)、β-内啡肽(β-EP)均下降,且B组低于A组(P<0.05)。结论:掌侧入路、背侧入路微创加压螺钉固定术治疗腕舟骨骨折,疗效相当,其中掌侧入路可减少术中出血量,促进骨折愈合,同时还可减轻术后疼痛、术后创伤,综合疗效相对更好。
Objective:To compare the curative effects of minimally invasive compression screw fixation via dorsal approach and volar approach in the treatment of scaphoid fracture,as well as their effects on serum trauma stress indexes and pain mediators.Methods:This study was a retrospective study,the clinical data came from 88 patients with scaphoid fracture who were treated in our hospital from January 2018 to January 2021.They were divided into group A(dorsal approach,43 cases)and group B(volar approach,45 cases)according to different approaches.The excellent and good rate of wrist function,perioperative related indexes,visual pain simulation score(VAS),wrist joint mobility,serum trauma stress indexes and pain mediators of the two groups were observed.Results:There was no significant difference in the excellent and good rate between the two groups(P>0.05).The intraoperative blood loss in the group B was less than that in the group A,and the time of bone healing was shorter than that in the group A(P<0.05).There was no difference in the operation time between the two groups(P>0.05).The VAS score in the group B at 6 months after operation was lower than that in the control A(P<0.05).The range of motion of wrist flexion,dorsiflexion,radial deviation and ulnar deviation increased in the two groups at 1 year after operation(P<0.05).The levels of cortisol(Cor),C-reactive protein(CRP)and adrenocorticotropic hormone(ACTH)increased in the two groups at 3d after operation,but group B was lower than group A(P<0.05).3 d after operation,prostaglandin E2(PGE2),substance P(SP)andβ-Endorphins(β-EP)decreased in the two groups,and group B was lower than group A(P<0.05).Conclusion:The treatment of scaphoid fracture with minimally invasive compression screw fixation by via dorsal approach and volar approach has similar efficacy.Among them,the volar approach can reduce intraoperative blood loss,promote fracture healing,and relieve postoperative pain and trauma,with relatively better comprehensive efficacy.
作者
史林
赵睿
田通
宋照
陈永祥
SHI Lin;ZHAO Rui;TIAN Tong;SONG Zhao;CHEN Yong-xiang(Department of Orthopaedics,The First Affiliated Hospital of Air Force Military Medical University,Xi'an,Shaanxi,710032,China;Department of Hand and Upper Limb Microsurgery,Xi'an Daxing Hospital,Xi'an,Shaanxi,710016,China)
出处
《现代生物医学进展》
CAS
2022年第23期4470-4474,共5页
Progress in Modern Biomedicine
基金
陕西省重点研发计划项目(2018SF-201)。
关键词
背侧入路
掌侧入路
微创加压螺钉固定术
腕舟骨骨折
疗效
创伤应激指标
疼痛介质
Dorsal approach
Via dorsal approach
Minimally invasive compression screw fixation
Scaphoid fracture
Curativ eeffect
Trauma stress index
Pain mediators
