术前皮牵引对髋部骨折疼痛改善及复位的影响

Effects of preoperative skin traction on pain relief and fracture reduction of patients with hip fracture

目的评估对髋部骨折患者术前进行皮牵引是否可有效减轻其疼痛及促进骨折复位。方法将2010年6月—2013年6月于浙江省富阳市富阳中医骨伤医院行髋部骨折手术的患者,通过计算机随机分组的方法随机分为皮牵引组及非皮牵引组。以视觉模拟评分（0～10）作为主要指标,进行疼痛程度的评估;以骨折复位情况作为次要指标,依据入院时、手术前1 d以及术后股骨长度及X线片（前后位）上颈干角的差异评估骨折复位情况。结果最终对106例患者进行数据分析,其中皮牵引组56例,非皮牵引组50例。两组患者的基线指标比较,差异均无统计学意义（P〉0.05）。皮牵引组患者在入院时、术前及术后的平均疼痛评分分别为4.4±0.8、2.9±0.5和1.4±0.4;而非皮牵引组的平均疼痛评分分别为4.5±0.7、2.8±0.6和1.6±0.5,两组差异无统计学意义（P〉0.05）。两组患者在止痛药的使用数量及骨折复位情况方面比较,差异亦无统计学意义（P〉0.05）。皮牵引组患者的红斑或水泡、肢体麻木及深静脉血栓等并发症的发生率明显高于非皮牵引组（P〈0.05）。结论术前皮牵引对患者术前疼痛缓解及术后骨折复位无明显影响,但有发生红斑或水泡、肢体麻木及深静脉血栓等并发症的可能。

Objective To evaluate whether preoperative skin traction can reduce the pain of patients with hip fracture and promote fracture reduction. Methods Patients who underwent hip fracture operations in the Fuyang Orthopaedics Hospital of Traditional Chinese Medicine from June 2010 to June 2013 were selected and randomly divided into the skin traction group and non-skin traction group by the computer. The primary index was visual analogue scale （0 -10） for evaluating the degree of pain. The secondary index was fracture reduction, which was evaluated according to the differences of femur length and neck shaft angle on X-rays （ anteroposterior view） at the time of admission, 1 d before operation, and after operation. Results Data of 106 cases were finally analyzed and 56 of them were from the skin traction group and 50 of them were from the non-skin traction group. The differences of basic line indexes between two groups were not statistically significant （P〉0.05）. The mean pain scores of skin traction group at the time of admission and before and after operation were 4.4 ＋0.8, 2.9 -l-0.5, and 1.4 ＋0.4, respectively, while those of the non-traction group were 4.5 ＋0.7, 2.8 ＋0.6, and 1.6 ＋0.5, respectively （P〉0.05）. The differences between two groups were not statistically significant （P〉0.05）. The differences of the dose of painkillers and the fracture reduction of two groups were not statistically significant （P 〉 0.05）. The incidence of erythema or blisters, numbness, and deep vein thrombosis of the skin traction group was significantly higher than that of the non-skin traction group （P 〈 0.05）. Conclusion Preoperative skin traction has no significant effect on preoperative pain relief and postoperative fracture reduction. But some complications such as erythema or blisters, numbness, and deep vein thrombosis may occur.