German Joint Centre Heidelberg, ATOS Clinic Heidelberg, Heidelberg, Germany.
Department for Traumatology and Orthopaedics, BG Trauma Centre Ludwigshafen, Ludwigshafen, Germany.
Bone Joint J. 2021 Apr;103-B(4):746-754. doi: 10.1302/0301-620X.103B4.BJJ-2020-1260.R1.
Complex joint fractures of the lower extremity are often accompanied by soft-tissue swelling and are associated with prolonged hospitalization and soft-tissue complications. The aim of the study was to evaluate the effect of vascular impulse technology (VIT) on soft-tissue conditioning in comparison with conventional elevation.
A total of 100 patients were included in this prospective, randomized, controlled monocentre study allocated to the three subgroups of dislocated ankle fracture (n = 40), pilon fracture (n = 20), and intra-articular calcaneal fracture (n = 40). Patients were randomized to the two study groups in a 1:1 ratio. The effectiveness of VIT (intervention) compared with elevation (control) was analyzed separately for the whole study population and for the three subgroups. The primary endpoint was the time from admission until operability (in days).
The mean length of time until operability was 8.2 days (SD 3.0) in the intervention group and 10.2 days (SD 3.7) in the control group across all three fractures groups combined (p = 0.004). An analysis of the subgroups revealed that a significant reduction in the time to operability was achieved in two of the three: with 8.6 days (SD 2.2) versus 10.6 days (SD 3.6) in ankle fractures (p = 0.043), 9.8 days (SD 4.1) versus 12.5 days (SD 5.1) in pilon fractures (p = 0.205), and 7.0 days (SD 2.6) versus 8.4 days (SD 1.5) in calcaneal fractures (p = 0.043). A lower length of stay (p = 0.007), a reduction in pain (p = 0.05; p < 0.001) and need for narcotics (p = 0.064; p = 0.072), an increased reduction in swelling (p < 0.001), and a lower revision rate (p = 0.044) could also be seen, and a trend towards fewer complications (p = 0.216) became apparent.
Compared with elevation, VIT results in a significant reduction in the time to achieve operability in complex joint fractures of the lower limb. Cite this article: 2021;103-B(4):746-754.
下肢复杂关节骨折常伴有软组织肿胀，与住院时间延长和软组织并发症相关。本研究旨在评估与传统抬高相比，血管脉冲技术（VIT）对软组织调理的效果。
这项前瞻性、随机、对照的单中心研究共纳入 100 例患者，分为外踝骨折（n = 40）、PILON 骨折（n = 20）和关节内跟骨骨折（n = 40）3 个亚组，按照 1:1 的比例随机分为两组。分别对整个研究人群和 3 个亚组进行 VIT（干预）与抬高（对照）的有效性分析。主要终点为从入院到可手术的时间（以天计）。
在所有 3 个骨折亚组中，干预组的平均可手术时间为 8.2 天（SD 3.0），对照组为 10.2 天（SD 3.7）（p = 0.004）。亚组分析显示，在 2 个亚组中，可手术时间显著缩短：外踝骨折分别为 8.6 天（SD 2.2）和 10.6 天（SD 3.6）（p = 0.043），PILON 骨折分别为 9.8 天（SD 4.1）和 12.5 天（SD 5.1）（p = 0.205），跟骨骨折分别为 7.0 天（SD 2.6）和 8.4 天（SD 1.5）（p = 0.043）。住院时间更短（p = 0.007），疼痛减轻（p = 0.05；p < 0.001），镇痛药需求减少（p = 0.064；p = 0.072），肿胀减轻更明显（p < 0.001），翻修率更低（p = 0.044），并发症更少（p = 0.216）。
与抬高相比，VIT 可显著缩短下肢复杂关节骨折的可手术时间。
文献来源：Bachmann A, Zechmeister D, Dreher D, et al. Vascular Impulse Technology for Soft Tissue Management in Patients with Complex Fractures of the Lower Limb: A Prospective, Randomized, Controlled Multicenter Study. J Bone Joint Surg Am. 2021;103-B(4):746-754.
