髋部骨折术后疼痛管理的随机对照研究  

Pain management after surgery in hip fracture patients: A randomized placebo controlled trial

作　　者：胡承方[1] 罗从风[1] 陈云苏[1] 张巍[1] 杨光[1] 朱奕[1] 

机构地区：[1]上海交通大学附属第六人民医院骨科,上海市200233

出　　处：《中国骨与关节损伤杂志》2012年第12期1065-1068,共4页Chinese Journal of Bone and Joint Injury

摘　　要：目的通过对髋部骨折术后患者进行疼痛评价,分析术后疼痛与骨折类型、手术方式、镇痛方法之间的关系,为进一步完善髋部骨折术后疼痛管理提供依据。方法采用前瞻性、随机对照研究,83例髋部骨折根据镇痛方法分成3组:①帕瑞昔布组;②塞来昔布组;③安慰剂组。根据手术方式不同分成4组:①空心钉内固定组;②DHS内固定组;③髓内钉内固定组;④髋关节置换组。比较术前、术后的疼痛视觉模拟评分(VAS),术后3 d的疼痛缓解程度,并发症率以及患者满意度。结果患者的年龄及骨折类型对髋部骨折术后疼痛的影响有限,DHS和髓内钉内固定组患者的疼痛程度比空心钉内固定和关节置换组要高;帕瑞昔布组在术后疼痛强度、疼痛缓解程度以及满意度方面与塞来昔布组和安慰剂组比较差异有统计学意义(P<0.05),但在并发症的发生率上差异无统计学意义(P>0.05)。结论要重视使用DHS和髓内钉内固定髋部骨折术后的疼痛管理,且帕瑞昔布对髋部手术术后镇痛的效果确切,具有安全、可靠、起效快的优点。Objective To analyze the relationship between postoperative pain and a variety of factors, including fracture type, type of surgery, and pain management protocol by performing pain assessment in hip fracture patients after surgery for the optimum protocol for postoperative pain management. Methods This was a prospective, randomized, placebo-controlled study. A total of 83 hip ＇fracture patients randomly received one of the three analgesics for pain control; i.e., pareeoxib, eelecoxib, and placebo. The surgical procedures that were used included cannulated screw internal fixation, dynamic hip screw （DHS） internal fixation, intramedullary nail internal fixation, and hip arthroplasty. Comparisons were made in visual analogue scale scores, pain relief of the first three postoperative days, incidence of complications, and patient satisfaction. Results No significant effect on pain after hip fracture surgery was found for patient age and type of procedure. There was more pain in patients undergoing DHS and intramedullary nail internal fixation than patients undergoing cannulated screw internal fixation and hip arthroplasty. Parecoxib was significantly superior to celecoxib and placebo in terms of postoperative pain intensity, pain relief, and satisfaction （P 〈0.05）. However, no significant difference was noticed in the incidence of complications among the three treatments（P 〉0.05）. Conclusion More attention should be paid to patients undergoing DHS and intramedullary nail internal fixation regarding better postoperative pain control. Parecoxib is superior to celecoxib in postoperative pain control in terms of being safe, reliable, and fast-acting.

关 键 词：疼痛 髋部骨折 内固定 髋关节置换 帕瑞昔布 

分 类 号：R969.4[医药卫生—药理学]