新型患肢固定牵引带在肩关节镜手术侧卧牵引位中的应用

Application of a new type of fixed traction belt for the affected limb in lateral traction position during shoulder arthroscopic surgery

目的探讨新型患肢固定牵引带在肩关节镜手术侧卧牵引位中的应用效果。方法选择2021年1月至12月于上海交通大学医学院附属瑞金医院骨科病区行肩关节镜手术的317例患者作为研究对象,按照随机数字表法分为观察组和对照组。观察组患者肩关节镜手术中使用新型患肢固定牵引带固定牵引患肢,对照组患者肩关节镜手术中使用皮肤牵引带固定牵引患肢,对两组患者术前体位准备的时间、体位摆放术者的满意度、术后体位恢复的时间、牵引相关术后并发症的发生情况进行比较。结果两组患者术后均完成至少3个月随访。观察组患者术前体位准备的时间为(4.55±1.05)min,少于对照组(6.65±1.15)min,组间比较差异有统计学意义(P<0.05);观察组体位摆放术者的满意度为(47.00±1.34)分,优于对照组(41.58±2.18)分,组间比较差异有统计学意义(P<0.05);观察组术后体位恢复的时间为(2.96±0.83)min,少于对照组(4.54±1.11)min,组间比较差异有统计学意义(P<0.05);观察组患者术后牵引相关并发症为0例,对照组术后牵引相关并发症为3例;两组患者术前美国肩肘外科协会评分差异无统计学意义(P>0.05),术后2周、6周、3个月随访美国肩肘外科协会评分均较术前有明显提高,组间比较差异无统计学意义(P>0.05)。结论新型肩关节镜患肢固定牵引带在侧卧牵引手术体位中的应用有利于肩关节镜手术的开展,缩短了手术术前体位安放的时间和术后体位恢复的时间,提高了体位摆放术者的满意度,降低了牵引相关的术后并发症的发生,具有临床推广价值。

Background In recent years,with the continuous progress of shoulder arthroscopy technology,shoulder arthroscopy has become a primary surgical method for rotator cuff injury and is becoming increasingly mature.With its advantages of small invasion,quick postoperative recovery,and intuitive operation,shoulder arthroscopy can be used to observe,diagnose and deal with shoulder joint lesions,successfully avoiding the shortcomings of traditional surgery with considerable trauma and many complications and improving the treatment comfort of patients.Appropriate surgical position affects the comfort of patients and is the basis for the success of shoulder arthroscopic surgery.Due to the shoulder joint’s unique anatomical morphology,most surgical positions are beach chair or lateral traction position,which is slightly less exposed to glenohumeral joint space.Moreover,controlled intraoperative hypotension is likely to cause a sharp decrease in cerebral perfusion volume and increase the risk of anesthesia,so lateral traction position has been more widely used in our hospital.The lateral traction position requires the patient to lean back 20°-30°,suspend the distal end of the affected limb in traction,abduct about 45°,bend forward 10°-15°,and put the upper limb in suspension position(the upper limb fixed traction equipment and traction frame are required to use).The traction strap used clinically for the affected limb is a skin traction strap,which means wrapping the forearm with a cotton pad,reserving bandages of sufficient length,wrapping the remaining bandages in a circular way from the far end of the arm to the near end,then folding and wrapping them around the wrist to tie and fix them,and connecting the reserved bandages to the traction rack at the end of the bed.There are some problems in using this method,such as extended time for preoperative position preparation and postoperative position recovery,poor traction effect,increasing assistant burden,inconvenient observation of traction direction during surgery,and easy-to-cause skin injury and vascular traction injury.Objective To investigate the effect of a new fixed traction belt for the affected limb in the lateral traction position during shoulder arthroscopic surgery.Methods From January to December 2021,317 patients who underwent shoulder arthroscopic surgery in the orthopedic ward of Shanghai Jiao Tong University School of Medicine Affiliated Ruijin Hospital were selected as the study subjects and were divided into observation group and control group according to a random number table method.The patients in the observation group used a new traction belt for fixation and traction of the affected limb during arthroscopic surgery on the shoulder.In contrast,the patients in the control group used a skin traction belt for fixation and traction of the affected limb during arthroscopic surgery on the shoulder.We compared the time for preoperative posture preparation,the operator's satisfaction with positioning,the time for postoperative posture recovery,and the incidence of postoperative complications related to traction between the two groups.Results Both groups completed at least three months of postoperative follow-up.The time of preoperative position preparation in the observation group was(4.55±1.05)min,less than that in the control group,(6.65±1.15)min,and the difference between groups was statistically significant(P<0.05).The patients'satisfaction in the observation group was(47.00±1.34)points,which was better than that in the control group at(41.58±2.18)points,and the difference between groups was statistically significant(P<0.05).The time of postural recovery in the observation group was(2.96±0.83)min,less than that in the control group,(4.54±1.11)min,and the difference was statistically significant(P<0.05).Postoperative tractor-related complications were none in the observation group and 3 cases in the control group.There was no statistically significant difference in ASES scores between the two groups before surgery(P>0.05),and the ASES scores at two weeks,six weeks,and three months after surgery were significantly higher than those before surgery.The two groups had no statistically significant difference(P>0.05).Conclusion The application of a new type of traction belt for the fixation of affected limbs in lateral traction surgery is beneficial to the development of shoulder arthroscopic surgery,shortening the time for preoperative posture placement and postoperative posture recovery,improving the satisfaction of posture placement operators,and reducing the occurrence of postoperative complications related to traction,which has clinical promotion value.