加速康复外科在创伤骨科无痛闭合整复桡骨远端骨折的前瞻性队列研究  

Enhanced Recovery After Surgery used in close reduction of distal radius fracture in emergency traumatic patients:a prospective cohort study

作　　者：肖鸿鹄 李庭[1] 米萌[1] 周力[1] 刘洪波[1] 高志强[1] 马若飞 孙铂林 李波 吴新宝[1] Xiao Honghu;Li Ting;Mi Meng;Zhou Li;Liu Hongbo;Gao Zhiqiang;Ma Ruofei;Sun Bolin;Li Bo;Wu Xinbao(Department of Orthopaedic Trauma,Beijing Jishuitan Hospital,Beijing 100035,China)

机构地区：[1]北京积水潭医院创伤骨科,100035

出　　处：《中华创伤骨科杂志》2019年第11期945-951,共7页Chinese Journal of Orthopaedic Trauma

摘　　要：目的比较麻醉与非麻醉下闭合手法复位桡骨远端骨折的疗效,评价基于加速康复外科(ERAS)理念的规范化麻醉下闭合整复的方法。方法选取2018年9月至2019年1月积水潭医院创伤骨科急诊就诊的186例桡骨远端骨折患者进行前瞻性队列研究。根据患者自身意愿,72例患者采用初步建立的基于ERAS理念臂丛神经阻滞麻醉下规范化闭合整复方法进行治疗(试验组);114例患者采用非麻醉下传统的闭合手法整复治疗(对照组)。比较两组患者的急诊复位次数、肿胀程度评分、再手术率、石膏拆除时间、腕关节患者自行评估量表(PRWE)的功能评分和Lidstr?m影像学评分。结果试验组和对照组分别有58、83例患者,随访至骨折愈合;分别有51、78例患者完成整复后6个月随访。试验组与对照组复位次数分别为(1.1±0.1)、(1.6±0.1)次,再手术率分别为2.8%(2/72)和12.3%(14/114),以上项目两组间比较差异均有统计学意义(P<0.05)。复位增加患肢肿胀,试验组与对照组复位后肿胀程度评分分别为(2.0±0.1)分和(2.6±0.1)分,差异有统计学意义(P<0.05)。试验组与对照组拆除石膏时间分别为(5.3±0.2)、(6.9±0.2)周,差异有统计学意义(P<0.05)。末次随访时试验组与对照组PRWE功能评分分别为(23.4±1.0)、(30.3±1.1)分,差异有统计学意义(P<0.05),但Lidstr?m影像学等级评分差异无统计学意义(P>0.05)。结论与传统的闭合复位相比,基于ERAS理念的急诊无痛闭合整复规范化的操作流程将改善患者的疼痛体验,提高复位成功率,降低复位后再手术率,并能有助于患者尽早拆除石膏,更好地恢复患者骨折愈合后的腕关节功能。Objective To compare the therapeutic effects between the anesthetic and non-anesthetic closed reduction protocols for distal radius fractures based on the concept of Enhanced Recovery After Surgery(ERAS).Methods A prospective study was conducted in a cohort of 186 patients with distal radius fracture who had been admitted to the Department of Orthopaedic Trauma,Beijing Jishuitan Hospital from September 2018 to January 2019.The patients were divided into 2 groups depending on the choice by themselves.Of them,72(intervention group)underwent the standardized closed reduction under brachial block anesthesia based on the concept of ERAS while the other 114(control group)conventional closed reduction under no anesthesia.The 2 groups were compared in terms of emergency reduction times,swelling scores,reoperation rate,splint removal time,functional outcomes by the Patient-Rated Wrist Evaluation(PRWE)and radiographic outcomes by the Lidstr?m criteria.Results The patients in both groups were followed up for 6 months.The reduction times were fewer in the intervention group than in the control group(1.1±0.1 versus 1.6±0.1,P<0.05).The reoperation rate was significautly lower in the intervention group than in the control group[2.8%(2/72)versus 12.3%(14/114),P<0.05].Reduction deteriorated the swelling condition.Compared with the control group,the swelling was significantly less in the intervention group(2.0±0.1 versus 2.6±0.1,P<0.05).The splint removal time for the intervention group(5.3±0.2 weeks)was significantly shorter than that for the control group(6.9±0.2 weeks)(P<0.05).The intervention group had significantly better PWRE scores than the control group(23.4±1.0 versus 30.3±1.1,P<0.05),but there was no significant difference between groups in the Lidstr?m evaluation(P>0.05).Conclusion Compared with conventional closed reduction,the closed reduction under anesthesia based on the ERAS concept is an effective method for the emergency treatment of distal radius fracture,because it may minimize the patients’pain exper

关 键 词：桡骨骨折 麻醉 超声检查 臂丛神经 闭合复位 

分 类 号：R68[医药卫生—骨科学]