夹板固定和皮肤牵引在粗隆间骨折患者术前固定的效果比较

doi:10.3969/j.issn.1009-976X.2020.06.015

摘要/Abstract

摘要： 目的比较夹板固定和皮肤牵引在粗隆间骨折患者术前固定的效果。方法回顾分析我院粗隆间骨折患者66例,按照术前固定方式分成夹板组和牵引组,每组33例。夹板组患者术前采用夹板固定,牵引组患者术前采用皮肤牵引固定。通过视觉模拟评分法（VAS）记录患者舒适程度、疼痛程度和满意度。通过制动舒适度问卷（ICQ）评估患者在术前固定期间的舒适水平。记录所有患者术前并发症发生情况。结果固定后15 min、1 h和2 h夹板组患者舒适评分均显著高于牵引组患者（P<0.05）。固定后1、2、3、4、5、6和7 d夹板组患者ICQ评分显著高于牵引组患者（P<0.05）。固定后15 min、1 h、2 h以及1、2、3、4和5 d夹板组患者疼痛评分显著低于牵引组患者（P<0.05）。固定后1、2、3、4、5、6和7 d夹板组患者满意度评分显著高于牵引组患者（P<0.05）。夹板组患者术前并发症总发生率显著低于牵引组患者（P<0.05）。结论术前夹板固定较皮肤牵引可进一步减小粗隆间患者疼痛程度和并发症发生率,提高患者舒适度和满意度,值得在临床上推广。

关键词: 粗隆间骨折, 夹板, 皮肤牵引, 固定

Abstract: Objective To compare preoperative immobilization effect between splint and skin traction in intertrochanteric fracture patients. Methods 66 intertrochanteric fracture patients were retrospectively analyzed. 66 patients were assigned to the splint group and the traction group according to the preoperative immobilization method （n=33）. Patients in the splint group received splint immobilization preoperatively, and patients in the traction group received skin traction. Patients′ comfort, pain and satisfaction were recorded by visual analogue scale （VAS）. Immobilization Comfort Questionnaire （ICQ） was used to evaluate patients′ comfort during preoperative immobilization period. Results Comfort VAS scores were significantly higher in the splint group than those in the traction group 15 min, 1 h and 2 h after immobilization （P< 0.05）. ICQ scores were significantly higher in the splint group than those in the traction group from 1 d to 7d after immobilization （P< 0.05）. Pain VAS scores were significantly lower in the splint group than those in the traction group 15 min, 1 h, 2 h, 1 d, 2 d, 3 d, 4 d, 5 d, 6 d and 7 d after immobilization （P< 0.05）. Satisfaction VAS scores were significantly higher in the splint group than those in the traction group from 1 d to 7 d after immobilization （P< 0.05）. Incidence rate of preoperative complication was significantly lower in the splint group than those in the traction group （P< 0.05）. Conclusion Preoperative splint immobilization could decrease pain level and incidence rate of complication and increase comfort and satisfaction in intertrochanteric fracture patients, which is worth popularizing clinically.

Key words: intertrochanteric fracture, skin traction, splint, immobilization

中图分类号:

R683.42

黄晓莹, 张燕, 陆映霞. 夹板固定和皮肤牵引在粗隆间骨折患者术前固定的效果比较[J]. 岭南现代临床外科, 2020, 20(06): 757-761.

HUANG Xiao-ying, ZHANG Yan, LU Ying-xia. Comparison of preoperative immobilization effect between splint and skin traction in intertrochanteric fracture patients[J]. Lingnan Modern Clinics in Surgery, 2020, 20(06): 757-761.

参考文献

[1] Yu X, Wang J, Wang X, et al.The efficacy and safety of tranexamic acid in the treatment of intertrochanteric fracture: an updated meta-analysis of 11 randomized controlled trials[J]. J Thromb Thrombolysis, 2020. doi: 10.1007/s11239-019-02034-1.[Epub ahead of print]
[2] Bovbjerg P, Froberg L, Schmal H.Short versus long intramedullary nails for treatment of intertrochanteric femur fractures (AO 31-A1 and AO 31-A2): a systematic review[J]. Eur J Orthop Surg Traumatol, 2019, 29(8): 1823-1831.
[3] Ju J, Zhang P, Jiang B.Hip Replacement as Alternative to Intramedullary Nail in Elderly Patients with Unstable Intertrochanteric Fracture: A Systematic Review and Meta-Analysis[J]. Orthop Surg, 2019,11(5):745-754.
[4] Maher AB, Meehan AJ, Hertz K, et al.Acute nursing care of the older adult with fragility hip fracture: An international perspective (Part 2)[J]. Int J Orthop Trauma Nurs, 2013,17(1):4-18.
[5] 张莉, 何利, 孟珊珊, 等. 中文版制动舒适度问卷在膝关节置换术后患者中应用的信效度分析[J]. 中华现代护理杂志, 2018,24(6):647-651.
[6] Sun D, Wang C, Chen Y, et al.A meta-analysis comparing intramedullary with extramedullary fixations for unstable femoral intertrochanteric fractures[J]. Medicine, 2019, 98(37): e17010.
[7] Kumar P, Rajnish RK, Sharma S, et al.Proximal femoral nailing is superior to hemiarthroplasty in AO/OTA A2 and A3 intertrochanteric femur fractures in the elderly: a systematic literature review and meta-analysis[J]. Int Orthop, 2020, 44(4): 623-633.
[8] Baransel S, Korhan O, Engin E, et al.Skin traction and placebo effect in the preoperative pain control of patients with collum and intertrochanteric femur fractures[J]. Bull NYU Hosp Jt Dis, 2010, 68(1): 15-7.
[9] Rosen JE, Chen FS, Hiebert R, et al.Efficacy of preoperative skin traction in hip fracture patients: a prospective, randomized study[J]. J Orthop Trauma, 2001,15(2):81-5.
[10] Alireza I, Nariman Sadeghi K, Fatemeh N, et al.A comparison between the effects of simple and traction splints on pain intensity in patients with femur fractures[J]. Iran J Nurs Midwifery Res, 2012,17(7):530-533.
[11] Dash SK, Panigrahi R, Palo N, et al.Fragility Hip Fractures in Elderly Patients in Bhubaneswar, India (2012-2014): A Prospective Multicenter Study of 1031 Elderly Patients[J]. Geriatr Orthop Surg Rehabil, 2015,6(1):11-15.
[12] Singh P, Kumar A, Shekhawat V, et al.Nonpathological Lesser Trochanter Fracture in Adult: Case Report and Brief Review of Literature[J]. J Clin Diagn Res, 2015,9(11):4-5.
[13] Bumpass DB, Ricci WM, McAndrew CM, et al. A prospective study of pain reduction and knee dysfunction comparing femoral skeletal traction and splinting in adult trauma patients[J]. J Orthop Trauma, 2015,29(2):112-118.
[14] Endo J, Yamaguchi S, Saito M, et al.Efficacy of preoperative skin traction for hip fractures: a single-institution prospective randomized controlled trial of skin traction versus no traction[J]. J Orthop Sci, 2013,18(2):250-255.
[15] Rosen JE, Chen FS, Hiebert R, et al.Efficacy of preoperative skin traction in hip fracture patients: a prospective, randomized study[J]. J Orthop Trauma, 2001,15(2):81-85.
[16] Koc S, Buker N, Savkin R, et al.The effects of independence and depression level on patients satisfaction with nursing care in orthopedic and traumatology patients[J]. J Kartal Train Res Hosp, 2012,23(1):130-136.
[17] Endo J, Yamaguchi S, Saito M, et al.Efficacy of preoperative skin traction for hip fractures: a single-institution prospective randomized controlled trial of skin traction versus no traction[J]. J Orthop Sci, 2013,18(2):250-255.