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闭合性胫腓骨骨折患者术前不同冷敷方案的应用效果

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目的 探讨不同冷敷方案在闭合性胫腓骨骨折术前的应用效果.方法 前瞻性研究分析2022年6月-2023年6月宿迁市第一人民医院骨科收治的因高能量损伤(如道路交通伤、高处坠落伤、或高速压缩力量所致)导致的222例闭合性胫腓骨骨折患者,男性120例,女性102例;年龄18~69岁,平均50.8岁.采用分时段收集样本资料方法,分为A组(持续冷敷)、B组、C组、D组(B、C、D组持续冷敷至肿胀高峰期后每冷敷1 h分别间隔30 min、1 h、2 h),待肿胀明显消退手术治疗后停止冷敷,分析四组患者冷敷12、24、48、72h的患肢肿胀值、疼痛评分(数字评定量表,NRS)和额外止痛药使用情况.结果 (1)持续冷敷24 h后的肿胀值(2.83±1.35)cm,达到峰值,高于持续冷敷 12 h(2.67±1.34)cm、48 h(2.43±1.34)cm 及 72 h(2.09±1.25)cm,且两两比较差异有统计学意义(P<0.05);(2)冷敷48、72 h后A、B组的肿胀值明显小于C、D 组,且 A、B 组肿胀差值[(0.56±0.26)cm、(0.60±0.52)cm]与 C、D 组[(0.31±0.33)cm、(0.30±0.25)cm]比较差异有统计学意义(P<0.05),A组与B组、C组与D组比较差异无统计学意义(P>0.05);(3)冷敷48、72 h后A、B组的NRS及额外止疼药使用人数[A组:(3.02±0.64)分、(2.88±0.55)分,13例;B组:(3.32±0.77)分、(3.03±0.57)分,20 例]均少于 C 组[(3.69±0.78)分、(3.35±0.56)分,36 例]、D 组[(3.75±0.65)分、(3.43±0.57)分,24例],且差异有统计学意义(P<0.05),A组与B组、C组与D组比较差异无统计学意义(P>0.05).结论 在四种冷敷方案中,A、B组方案均有利于患肢消肿与减轻疼痛,并减少额外止疼药使用次数.
Application effects of different preoperative cold compress methods in patients with closed tibia and fibula fractures
Objective To explore the effect of different cold compress methods applied to patients with closed tibia and fibula fractures before surgery.Methods A prospective study was conducted on 222 cases of closed tibia and fibula fractures following high-energy trauma,who were all treated at the First People's Hospital of Suqian from Jun.2022 to Jun.2023.Among them,there were 120 males and 102 females aged 18-69 years,with an average age of 50.8 years.Based on the admission time,patients were divided into Group A(continuous cold compress)and Groups B-D(continuous cold compress until the peak of swelling and then changed into every 1 h cold compress with 30 min,1 h or 2 h pause).After severe swelling subsided,patients received surgery and then cold compress treatment was stopped.The swelling value of the affected limb and numerical rating scale(NRS)at 12,24,48 and 72 h were recorded,as well as the additional use of analgesics.Results(1)After continuous cold compress,the swelling of the limb(cm)reached the peak at 24 h(2.83±1.35),much higher than that at 12 h(2.67±1.34),48 h(2.43±1.34),and 72 h(2.09±1.25),with statistically significant differences between any two time-points(all P<0.05).(2)After 48 and 72 h cold compress,Groups A and B showed significantly milder swelling compared to Groups C and D(all P<0.05).Moreover,the swelling differences(cm)in Groups A(0.56± 0.26)and B(0.60±0.52)were much higher than that in Groups C(0.31±0.33)and D(0.30±0.25,P<0.05),but the differences between Groups A and B or Groups C and D were insignificant(P>0.05).(3)After 48 and 72 h of cold compress,the NRS and the use of additional analgesics revealed similar results,with the NRS being 3.02±0.64,3.32±0.77,3.69±0.78,3.75±0.65 in Groups A-D at 48 h and 2.88±0.55,3.03±0.57,3.35±0.56,3.43±0.57 at 72 h,and the number of patients with ≥1 additional use of analgesics was 13,20,36,24,all were much better in Groups A and B than in Groups C and D(P<0.05),but the differences between Groups A and B or Groups C and D were insignificant(P>0.05).Conclusion Among the four cold compress methods,Groups A and B are more beneficial for reducing swelling of the affected limb,alleviating pain,and decreasing additional use of an-algesics.

Closed tibia and fibula fracturesPreoperativeCold compress methods

程利文、张伟、张凌峰、邓杰林、张玲

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江苏大学医学院,江苏 镇江 212000

宿迁市第一人民医院骨科一病区,江苏 宿迁 223800

江苏大学京江学院,江苏 镇江 212000

闭合性胫腓骨骨折 术前 冷敷方案

江苏省高等教育学会"十四五"高等教育科学研究规划课题

YB012

2024

创伤外科杂志
第三军医大学,大坪医院,野战外科研究所

创伤外科杂志

CSTPCD
影响因子:1.017
ISSN:1009-4237
年,卷(期):2024.26(4)
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