Department of Plastic and Reconstructive Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea.
Department of Plastic and Reconstructive Surgery, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul 03312, Republic of Korea.
Medicina (Kaunas). 2023 Apr 17;59(4):783. doi: 10.3390/medicina59040783.
The expedient resolution of postoperative soft tissue edema is particularly important in hand surgery. Prolonged edema and pain become an obstacle to postoperative rehabilitation, delay return to daily life, and in severe cases, lead to a permanent decrease in range of motion. Based on the common physiology between postoperative hand swelling and complex regional pain syndrome (CRPS), we sought to determine if postoperative mannitol and steroid administration to multiple metacarpal bone fracture patients effectively reduces hand swelling and pain and is beneficial for hand rehabilitation. From March 2015 to February 2019, 21 patients who received closed pinning for multiple metacarpal fractures were included in a retrospective cohort study. The control group ( = 11) underwent a routine recovery, while the treatment group ( = 10) received dexamethasone and mannitol injections for five days postoperatively. Serial changes in the degree of pain and fingertip-to-palm distance (FPD) were measured in both groups. The duration from surgery to the initiation of rehabilitation and time to full grip was also compared. Compared to the control, the treatment group showed a faster alleviation of pain scores from the postoperative fifth day (2.91 versus 1.80, = 0.013), and faster recovery of FPD from postoperative two weeks (3.27 versus 1.90, = 0.002). Time to physical therapy initiation (6.73 versus 3.80 days, = 0.002) and full grip achievement (42.46 versus 32.70 days, = 0.002) were also faster in the treatment group. The steroid-mannitol combination treatment for multiple metacarpal bone fracture patients in the acute postoperative phase promoted the reduction of hand edema and pain, leading to the earlier initiation of physical therapy, rapid improvement in joint motion, and faster achievement of full grip.
术后软组织水肿的及时处理在手外科中尤为重要。长期的水肿和疼痛会成为术后康复的障碍，延迟日常生活的恢复，在严重的情况下，还会导致永久性的活动范围减小。基于术后手部肿胀和复杂性局部疼痛综合征（CRPS）之间的共同生理学原理，我们试图确定术后向多发性掌骨骨折患者多次给予甘露醇和类固醇是否能有效减轻手部肿胀和疼痛，是否有利于手部康复。
从 2015 年 3 月至 2019 年 2 月，我们对 21 例接受闭合克氏针固定治疗的多发性掌骨骨折患者进行了回顾性队列研究。对照组（n = 11）接受常规康复治疗，而治疗组（n = 10）则在术后 5 天内接受地塞米松和甘露醇注射治疗。在两组中，都测量了疼痛程度和指尖到手掌距离（FPD）的连续变化。比较两组患者从手术到开始康复以及完全握力的时间。
与对照组相比，治疗组术后第 5 天疼痛评分的缓解速度更快（2.91 分比 1.80 分， = 0.013），术后 2 周 FPD 的恢复速度也更快（3.27 分比 1.90 分， = 0.002）。开始物理治疗的时间（6.73 天比 3.80 天， = 0.002）和完全握力的获得时间（42.46 天比 32.70 天， = 0.002）也更快。
在急性术后阶段，对多发性掌骨骨折患者联合使用类固醇和甘露醇可促进手部水肿和疼痛的减轻，从而更早地开始物理治疗，更快地改善关节活动度，并更快地实现完全握力。
