Bradshaw Florence, Wakefield Edward, Zhang James, Tandon Ansh, Krkovic Matija
School of Clinical Medicine, University of Cambridge, Cambridge, GBR.
Orthopaedics, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, GBR.
Cureus. 2024 Feb 24;16(2):e54811. doi: 10.7759/cureus.54811. eCollection 2024 Feb.
Introduction Poller screws optimise fracture alignment in those fractures managed with intramedullary (IM) nails. They enhance stability, control nail insertion, and prevent translation. Indications encompass acute fractures, delayed unions/non-unions, and deformity. Classified into four generations, they've shown positive outcomes: improved alignment, reduced complications, and shorter healing. However, their pain management impact is understudied. This retrospective cohort study aimed to compare opioid medication needs in tibial fractures managed with IM nails with and without poller screws. Methods Between January 2015 and December 2022, a retrospective analysis was conducted on tibial fractures treated at a major trauma centre. Patients primarily treated with IM nails were included. Patient and operation notes as well as radiographs, were reviewed to identify poller screw utilisation. Opioid medication data was collected and converted to "coverage" (days) and "strength" (morphine milligrams equivalent or MME). Two-tailed independent samples T-tests were performed to determine differences between patients treated with (n=205) and without poller screws (n=540). Results Patients with poller screws had fewer days with opioid prescriptions in the second post-operative month (6.8 vs. 8.9 days, p=0.038) and significantly lower opioid strength requirements across the first post-operative year (688.4 vs. 1295.4 MME, p=0.001), except the first month. Conclusion There is limited research on the connection between poller screws and pain. This study discusses their potential to reduce post-operative pain in tibial fractures. The results highlight the importance of using poller screws alongside IM. This combination appears to be effective in improving post-operative pain management and enhancing overall patient outcomes.
引言
在使用髓内钉治疗的骨折中，Poller螺钉可优化骨折对线。它们可增强稳定性、控制髓内钉插入并防止移位。适应证包括急性骨折、延迟愈合/不愈合以及畸形。Poller螺钉分为四代，已显示出积极效果：改善对线、减少并发症并缩短愈合时间。然而，它们对疼痛管理的影响研究不足。这项回顾性队列研究旨在比较使用和不使用Poller螺钉的髓内钉治疗胫骨骨折患者的阿片类药物需求。
方法
2015年1月至2022年12月期间，对一家主要创伤中心治疗的胫骨骨折进行回顾性分析。纳入主要接受髓内钉治疗的患者。查阅患者和手术记录以及X线片，以确定Poller螺钉的使用情况。收集阿片类药物数据并转换为“覆盖天数”和“强度”（吗啡毫克当量或MME）。进行双尾独立样本t检验，以确定使用Poller螺钉的患者（n = 205）和未使用Poller螺钉的患者（n = 540）之间的差异。
结果
使用Poller螺钉的患者在术后第二个月的阿片类药物处方天数较少（6.8天对8.9天，p = 0.038），并且在术后第一年除第一个月外，阿片类药物强度需求显著较低（688.4 MME对1295.4 MME，p = 0.001）。
结论
关于Poller螺钉与疼痛之间联系的研究有限。本研究探讨了它们减轻胫骨骨折术后疼痛的潜力。结果强调了在使用髓内钉的同时使用Poller螺钉的重要性。这种组合似乎在改善术后疼痛管理和提高患者总体预后方面有效。
