闭合性胫腓骨骨折患者术前不同冷敷方案的应用效果

Application effects of different preoperative cold compress methods in patients with closed tibia and fibula fractures

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、72 h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。

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 analgesics.