在体氧调控对C型桡骨远端骨折愈合的作用

Effect of in-vivo oxygen regulation on type C distal radius fracture healing

目的分析在体氧调控(IV-OR)对C型桡骨远端骨折愈合的影响。方法2017年6月至2020年6月就诊于首都医科大学附属北京朝阳医院骨科并行手术治疗后的C型桡骨远端骨折患者64例。采用前瞻性队列研究的方法,将入组患者分为2组。IV-OR组26例患者;其中男10例,女16例;年龄中位数为62岁。对照组38例患者;男13例女25例;年龄中位数为64岁。IV-OR组于术后第1天开始至术后2周予以IV-OR治疗,使用自制充气加压装置捆绑于患肢肘上2~3 cm处,充气30 s(或者患者能忍受的最长时间),放气30 s;重复30循环;每天2次。对照组单纯捆绑充气加压装置,但不予IV-OR处理。观察患者骨折愈合时间、术后患肢疼痛评分、视觉模拟评分法(VAS)术后腕周径及掌厚度、术后腕关节活动度、术后患者腕关节等级评分(PRWE)等。结果IV-OR组患者骨折愈合时间为7.5(1)周;对照组患者骨折愈合时间为8(1.25)周;两组差异有统计学意义(统计值309.50,P<0.01)。IV-OR组患者术后第1、3天,1、2周疼痛评分均低于对照组(统计值分别为59.00、260.00、297.00、250.50,P<0.01),但在术后4周、8、12周与对照组差异无统计学意义(统计值分别为389.50、428.00、414.50,P=0.11、0.29、0.22)。IV-OR组患者术后2、4周腕周径及掌厚度均低于对照组(统计值分别为-7.92、-5.02,166.50、151.00,P<0.01),但在术后8、12周与对照组差异无统计学意义。IV-OR组患者在术后4周PRWE评分低于对照组(统计值为-5.27,P<0.01),但在术后8、12周时与对照组差异无统计学意义(统计值为-1.72、-1.20,P=0.09、0.23)。IV-OR组患者在术后2、4周时,患肢腕关节活动度高于对照组,差异有统计学意义,但在术后8、12周时与对照组差异无统计学意义。结论IV-OR是一种安全可靠且简单易行的促进骨折愈合的方法。

Objective To analyze the effect of in vivo oxygen regulation(IV-OR)on type C distal radius fracture healing.Methods From June 2017 to June 2020,a prospective cohort study was conducted in 64 patients with type C distal radius fractures treated in Department of Orthopedics,Affiliated Beijing Chaoyang Hospital of Capital Medical University.The enrolled patients were divided into two groups.There were 26 patients in IV-OR group,including 10 males and 16 females with a median age of 62 years.There were 38 patients in the control group,13 males and 25 females with a median age of 64 years.The IV-OR group was treated with IV-OR from the first day to the second week after operation.The self-made inflatable compression device was bound at 2-3 cm above the elbow of the affected limb,inflated for 30 s(or the longest time the patient could endure),deflated for 30 s,and repeated 30 cycles twice a day.The control group was simply bound with inflatable compression device,but not treated with IV-OR.The fracture healing time,postoperative limb pain score,postoperative wrist circumference and palm thickness,postoperative wrist range of motion,VAS and postoperative PRWE score were observed.Results The fracture healing time was 7.5(1)weeks in the IV-OR group and 8(1.25)weeks in the control group.There was significant difference between the two groups(Statistical value 309.50,P<0.01).The pain score of the IV-OR group was significantly lower than the control group at 1,3 days,1,2 weeks after operation(Statistical value 59.00,260.00,297.00,250.50,P<0.01);but there was no significant difference at 4,812 weeks after operation(Statistical value 389.50,428.00,414.50,P=0.11,0.29,0.22).The wrist circumference and palm thickness of the patients in the IV-OR group were lower than those in the control group at 2 and 4 weeks after operation(Statistical value-7.92,-5.02;166.50,151.00,P<0.01);but there was no significant difference at 8 and 12 weeks after operation.The PRWE score of the IV-OR group was lower than the control group at 4 weeks after operation;the difference was statistically significant(Statistical value-5.27,P<0.01);but there was no significant difference at 8 and 12 weeks after operation(Statistical value-1.72,-1.20,P=0.09,0.23).The wrist mobility of the wrist mobility of the affected limb in the IV-OR group was significantly higher than that in the control group at 2 and 4 weeks after operation;but there was no significant difference at 8 and 12 weeks after operation.Conclusion IV-OR is a safe,reliable and simple method to promote fracture healing.