长、短髓内钉治疗老年转子间骨折患者术后疼痛及镇痛药物使用剂量的对比研究  

Comparison of postoperative pain and analgesic drug consumption between long and short intra medullary nail in the treatment of elderly patients with intertrochanteric fracture

作　　者：丁罗兵 徐维臻 刘晖 罗德庆 张金辉 吴进 DING Luobing;XU Weizhen;LIU Hui;LUO Deqing;ZHANG Jinhui;WU Jin(Department of Orthopedics,the 909th Hospital of Joint Logistics Support Force of PLA(Dongnan Hospital of Xiamen University),Zhangzhou,Fujian 363000,China)

机构地区：[1]中国人民解放军联勤保障部队第九〇九医院(厦门大学附属东南医院)骨科,福建漳州363000

出　　处：《中国骨科临床与基础研究杂志》2024年第2期93-97,共5页Chinese Journal of Orthopaedic Clinical and Basic Research

基　　金：全军后勤科研项目(20XLS21)。

摘　　要：目的比较长、短髓内钉治疗老年转子间骨折患者术后疼痛以及镇痛药物使用剂量情况。方法回顾性分析2021年1月—2022年12月采用髓内钉治疗的190例老年岁股骨转子间骨折患者的临床资料,将髓内钉长度≥280 mm的80例纳入长钉组,≤240 mm的110例纳入短钉组。比较两组患者首次打开镇痛泵时间、术后0~24 h和24~48 h疼痛视觉模拟量表(VAS)评分及术后镇痛药物使用剂量。结果长钉组和短钉组术后0~24 h、24~48 h疼痛VAS评分比较,差异无统计学意义(P>0.05)。长钉组首次打开镇痛泵时间早于短钉组[(10.32±2.57)h比(13.42±1.29)h],术后布洛芬[(1.10±0.11)g比(0.80±0.09)g]、曲马多[(0.30±0.02)g比(0.20±0.01)g]和氨酚羟考酮[(0.99±0.07)g比(0.66±0.04)g]使用剂量均高于短钉组,差异有统计学意义(P<0.001)。结论对于老年股骨转子间骨折患者,长髓内钉较之短髓内钉可能增加术后疼痛风险及镇痛药物的使用剂量。Objective To compare the postoperative pain and analgesic drug consumption of long and short intramedullary nail in the treatment of intertrochanteric fracture in the elderly.Methods A retrospective analysis was performed on clinical data of 190 elderly patients with intertrochanteric fracture who were treated with intramedullary nail from January 2021 to December 2022.Eighty patients with intramedullary nail length more than or equal to 280 mm were included in the long nail group,and 110 patients with intramedullary nail length less than or equal to 240 mm were included in the short nail group.The time when the analgesic pump was first turned on,the pain score of visual analogue scale(VAS)at 0-24 h and 24-48 h after surgery,and the dosage of postoperative analgesic drugs were compared between the two groups.Results There were no statistical differences in pain VAS scores between the long nail group and the short nail group at 0-24 h and 24-48 h after surgery(both P>0.05).In the long nail group,the time of first opening of analgesic pump was earlier than that in short nail group[(10.32±2.57)h vs(13.42±1.29)h],the postoperative doses of ibuprofen[(1.10±0.11)g vs(0.80±0.09)g],tramadol[(0.30±0.02)g vs(0.20±0.01)g],and oxycodone acetaminophen[(0.99±0.07)g vs(0.66±0.04)g]were all higher than those of short nail group,the differences were statistically significant(all P<0.001).Conclusions In elderly patients with intertrochanteric fractures of the femur,the use of long intramedullary nails may be associated with an increased risk of postoperative pain and a higher requirement for analgesic medication when compared with short intramedullary nails.

关 键 词：老年人 髋骨折 骨折固定术 髓内 髓内钉 主钉长度 手术后并发症 视觉模拟量表 镇痛药 

分 类 号：R683.421[医药卫生—骨科学] R687.33[医药卫生—外科学] R971.2[医药卫生—临床医学]