Department of Orthopedic Surgery, Karatsu Red Cross Hospital, 1-5-1 Futago, Karatsu, Saga, 847-8588, Japan; Department of Orthopedic Surgery, Faculty of Medicine, Saga University, 5-1-1 Nabeshima, Saga, 849-8501, Japan.
Department of Surgery, Jichi Medical University, Shimotsuke, 3311-1 Yakushiji, Shimotsuke, Tochigi, 329-0498, Japan.
Int J Orthop Trauma Nurs. 2020 May;37:100754. doi: 10.1016/j.ijotn.2020.100754. Epub 2020 Jan 30.
The primary aim of the study was to investigate pain relief after more than 24 h of preoperative skin traction (because of delay in surgery due to comorbidities and system issues) in patients with intertrochanteric fractures.
We performed a retrospective comparative cohort study of 56 patients who underwent intramedullary nailing for the treatment of intertrochanteric fractures and who had waited for surgery for more than 48 h after admission due to comorbidities or system issues. Preoperative therapy was randomly selected with a ratio of one to two and patients classified as skin traction (n = 18) or no traction (n = 38). The Verbal Rating Scale (VRS) was used to assess pain at 12-60 h post-admission.
There was no significant difference in VRS at 12 h after admission (1.1 ± 1.0 vs. 0.8 ± 0.9, p = 0.73), but patients who received skin traction had a lower VRS pain score at 24-60 h after admission compared to those with no traction (24 h, 0.4 ± 0.8 vs. 1.1 ± 1.0, p < 0.05; 36 h, 0.2 ± 0.5 vs. 0.9 ± 0.9, p < 0.05; 48 h, 0.2 ± 0.4 vs. 0.8 ± 0.9, p < 0.05; 60 h, 0.2 ± 0.4 vs. 0.9 ± 0.9, p < 0.05).
Skin traction for patients with intertrochanteric fractures for more than 24 h preoperatively resulted in a lower VRS pain score. Therefore, more than 24 h of preoperative skin traction for patients with intertrochanteric fractures may give effective pain relief in situations where surgery is delayed.
本研究的主要目的是探讨由于合并症和系统问题导致手术延迟超过 24 小时后，股骨转子间骨折患者术前皮肤牵引超过 24 小时后的止痛效果。
我们对 56 例行髓内钉治疗股骨转子间骨折的患者进行了回顾性对比队列研究，这些患者由于合并症或系统问题入院后等待手术超过 48 小时。术前治疗采用 1:2 的随机选择，将患者分为皮肤牵引组（n=18）或无牵引组（n=38）。采用视觉模拟评分（VRS）评估入院后 12-60 小时的疼痛。
入院后 12 小时 VRS 评分无显著差异（1.1±1.0 与 0.8±0.9，p=0.73），但接受皮肤牵引的患者在入院后 24-60 小时的 VRS 疼痛评分低于无牵引的患者（24 小时：0.4±0.8 与 1.1±1.0，p<0.05；36 小时：0.2±0.5 与 0.9±0.9，p<0.05；48 小时：0.2±0.4 与 0.8±0.9，p<0.05；60 小时：0.2±0.4 与 0.9±0.9，p<0.05）。
对于术前皮肤牵引超过 24 小时的股骨转子间骨折患者，皮肤牵引可降低 VRS 疼痛评分。因此，对于手术延迟的股骨转子间骨折患者，术前皮肤牵引超过 24 小时可能会有效缓解疼痛。
