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。
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-αlevels 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.
作者
沈林华
蔡程名
高尚
董雨青
SHEN Linhua(No.970 Hospital of Joint Logistics Support Force,Shandong Yantai 264002,China)
出处
《河北医学》
CAS
2024年第6期1035-1040,共6页
Hebei Medicine
基金
山东省优秀中青年科学家科研奖励基金,(编号:BS2018SW412)。
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
Distal radius and ulna fractures
Plate fixation
Interlocking intramedullary nail fixation
Inflammatory stress
Pain level
