Endo Jun, Yamaguchi Satoshi, Saito Masahito, Itabashi Takashi, Kita Kouji, Koizumi Wataru, Kawaguchi Yoshikuni, Asaka Tomomi, Saegusa Osamu
Department of Orthopaedic Surgery, Japanese Red Cross Narita Hospital, 90-1 Iida-cho, Narita, Chiba 286-8523, Japan.
J Orthop Sci. 2013 Mar;18(2):250-5. doi: 10.1007/s00776-012-0338-1. Epub 2012 Nov 28.
Preoperative traction for hip fractures is of no benefit in semi-urgent surgery. However, its efficacy has not been assessed in cases in which emergency surgery was not possible. We evaluated the efficacy of preoperative skin traction for hip fractures in a level II trauma center in Japan where many patients undergo delayed surgery.
We undertook a randomized controlled trial. Eighty-one patients were randomized to be treated with skin traction (41 patients), or bed rest (40 patients). Preoperative pain was assessed by use of a visual analogue scale and the number of analgesics required. Fracture reduction was measured on the basis of leg-length and neck-shaft angle discrepancies on the radiograph on admission, a day before surgery, and after surgery.
The mean time from admission to surgery was 7.5 days. Pain decreased markedly on the day after admission in both the traction and no-traction groups. No significant difference was found during the preoperative waiting period between the groups in either pain score or number of analgesics taken. No significant difference was found in radiographic data either before or after surgery, and satisfactory reduction was achieved after surgery irrespective of the use of skin traction.
In our single-institution prospective randomized controlled trial, preoperative skin traction for patients with hip fracture had no effect on pain relief before surgery or reduction of fracture displacement during surgery, irrespective of preoperative waiting time.
对于半急诊手术，髋部骨折术前牵引并无益处。然而，在无法进行急诊手术的情况下，其疗效尚未得到评估。我们在日本一家二级创伤中心评估了髋部骨折术前皮肤牵引的疗效，该中心有许多患者接受延迟手术。
我们进行了一项随机对照试验。81例患者被随机分为接受皮肤牵引治疗组（41例患者）和卧床休息组（40例患者）。术前疼痛采用视觉模拟量表评估，并记录所需镇痛药的数量。根据入院时、手术前一天和手术后的X线片上的腿长和颈干角差异来测量骨折复位情况。
从入院到手术的平均时间为7.5天。牵引组和非牵引组在入院后第二天疼痛均明显减轻。术前等待期间，两组在疼痛评分或服用镇痛药数量方面均未发现显著差异。手术前后的影像学数据也未发现显著差异，无论是否使用皮肤牵引，术后均实现了满意的复位。
在我们的单机构前瞻性随机对照试验中，髋部骨折患者术前皮肤牵引对术前疼痛缓解或手术期间骨折移位的减少均无影响，无论术前等待时间长短。
