加速康复外科理念在可吸收棒治疗掌骨骨折中的运用

Application of accelerated rehabilitation surgery concept in the treatment of metacarpal fractures with absorbable rods

目的探讨在加速康复外科理念指导下可吸收棒治疗掌骨骨折的临床疗效。方法自2016年8月至2018年8月我们共收治53例(59处)掌骨长斜形和螺旋形骨折患者,采用可吸收棒垂直骨折线固定技术治疗。根据围手术期采用加速康复外科理念技术干预治疗与否将患者分为观察组和对照组。观察组24例(28处),对照组29例(31处).比较两组患者术后第一天视觉模拟评分(visual analogue scale,VAS).掌指关节主动活动度恢复正常的时间、骨折愈合时间以及末次随访时手功能评定结果。结果所有患者均获得随访,时间为1~12个月,平均9.2个月,切口均Ⅰ期愈合,所有骨折均愈合。观察组术后第一天VAS及掌指关节活动度恢复正常时间分别为(2.64±0.81)分、(19.35±2.12)d,明显低于对照组(3.42±1.13)分、(28.63±1.31)d,差异有统计学意义(t=-2.920、-14.665,P<0.05);两组患者骨折愈合时间分别为(8.13±1.22)周、(8.41±1.16)周,比较差异无统计学意义(t=-0.850,P>0.05).末次随访两组手功能评定结果比较差异无统计学意义(χ^2=0.05,P>0.05).结论可吸收棒垂直骨折线固定技术治疗掌骨长斜形或螺旋形骨折是一种安全有效的手术方法,结合加速康复外科理念技术的指导治疗,能使手功能恢复更佳,获得较满意的临床疗效。

Objective To explore the clinical efficacy of absorbable rod in the treatment of metacarpal fractures under the guidance of accelerated rehabilitation surgery concept. Methods From August 2016 to August 2018, 53 patients with long oblique and spiral metacarpal fractures were treated with absorbable rod by fixation perpendicular to the fracture line. The patients were divided into observation group and control group according to whether they were treated with the concept of accelerated rehabilitation surgery during perioperative period or not. There were 24 cases in the observation group (28 places) and 29 cases in the control group (31 places). The visual analogue scale (VAS) on the first day after operation, the time when the active range of motion of metacarpophalangeal joint returned to normal, the time of fracture healing and the functional evaluation results of the injured hand at the last follow-up were compared between the two groups. Results All the patients were follow-up for 1 to 12 months with an average of 9.2 months. All the incisions achieved primary healing and all the fractures were healed. On the first day after operation, VAS and the recovery time of metacarpophalangeal joint activity in the observation group were (2.64±0.81) points and (19.35±2.12) days, respectively, which were significantly lower than those in the control group (3.42±1.13) points and (2&63±1.31) days. The differences were statistically significant (t=-2.920,-14.665, P<0.05). The healing time of fracture in the two groups was (8.13±1.22) weeks and (&41±1.16) weeks, respectively. There was no significant difference between the two groups (t=-0.850, P>0.05). There was no significant difference in hand function evaluation between the two groups at the last follow-up (χ^2=0.045, P>0.05). Conclusion The technique of absorbable rod by fixation perpendicular to the fracture line for long oblique or spiral metacarpal fractures is a safe and effective surgical method. With the guidance of accelerated rehabilitation surgery concept, hand function can be better restored and satisfactory clinical efficacy can be obtained.