摘要
目的比较改良与常规肠道准备在骨盆骨折患者经皮骶髂螺钉内固定治疗中的应用效果。方法采用前瞻性队列研究分析2023年4月至2023年7月宁波市第六医院收治的59例骨盆骨折患者的临床资料,其中男42例,女17例;年龄42~62岁[(51.1±11.9)岁]。骨折Tile分型:B型30例,C型29例。按随机数字表法分为改良肠道准备组(29例)与常规肠道准备组(30例)。患者均行经皮骶髂螺钉内固定治疗。2组均在术前1 d夜间进行肠道准备。改良肠道准备组使用乳果糖联合甘油灌肠剂,仰卧位进行肠道准备;常规肠道准备组使用肥皂溶液,侧卧位进行肠道准备。比较2组单次肠道准备时长、肠道准备灌肠次数、不良反应发生率、灌肠过程中疼痛及焦虑程度视觉模拟评分(VAS)、术中X线透视图像质量评分、手术时长、术后首次肠道通气时长、术后3 d和5 d及出院后1周伤口情况、出院后1年Majeed功能评分。结果2组患者一般资料比较,差异均无统计学意义。患者均获随访10~13个月[(11.8±1.2)个月]。改良肠道准备组单次肠道准备时长为5.4(5.1,6.0)min,肠道准备灌肠次数为1.0(1.0,1.0)次,均短于或少于常规肠道准备组的22.8(15.5,31.4)min、1.5(1.0,2.0)次(P<0.01)。2组不良反应发生率差异无统计学意义(P>0.05)。改良肠道准备组灌肠过程中疼痛及焦虑程度VAS分别为3.0(2.5,3.5)分、3.0(2.0,3.0)分,均低于常规肠道准备组的6.0(5.0,7.0)分、6.0(5.0,7.0)分(P<0.01)。改良肠道准备组术中X线透视图像质量评分为2.0(2.0,3.0)分,高于常规肠道准备组的1.0(1.0,2.0)分(P<0.01)。2组手术时长差异无统计学意义(P>0.05)。改良肠道准备组术后首次肠道通气时长为3.0(2.0,4.0)h,早于常规肠道准备组的8.0(6.0,8.5)h(P<0.01)。2组术后3、5 d及出院后1周伤口情况,以及出院后1年Majeed功能评分差异均无统计学意义(P>0.05)。结论对于骨盆骨折行经皮骶髂螺钉内固定患者,与常规肠道准备相比,改良肠道准备具有肠道准备操作简便、灌肠过程中疼痛与焦虑减轻、术中X线透视图像质量提高、术后肠道功能恢复良好的优势。
Objective To compare the efficacy of modified and conventional preoperative bowel preparation in patients with pelvic fractures treated with percutaneous iliosacral screw fixation.MethodsA prospective cohort study was conducted on 59 patients with pelvic fractures admitted to Ningbo No.6 Hospital from April to July 2023.The patients were divided into modified bowel preparation group and conventional bowel preparation group using simple random numbers.All patients were treated with percutaneous iliosacral screw fixation.Both groups underwent bowel preparation on the night before surgery.In the modified bowel preparation group,lactulose combined with a glycerin enema was administered with the patients in the supine position.In the conventional bowel preparation group,a soap solution was used with the patients in the lateral position.The two groups were compared in terms of the time for the single bowel preparation,number of enema,incidence of adverse reactions,visual analogue scale(VAS)scores for pain and anxiety during enema,intraoperative X-ray image quality rating,operative duration,time to first postoperative flatus,wound condition at 3 and 5 days postoperatively and 1 week after discharge as well as Majeed functional score at 1 year after discharge.ResultsA total of 59 patients with pelvic fractures were included,comprising 42 males and 17 females,aged 42-62 years[(51.1±11.9)years].There were 29 patients in the modified bowel preparation group and 30 in the conventional bowel preparation group,with no statistically significant difference in terms of baseline characteristics(P>0.05).All patients were followed up for 10-13 months[(11.8±1.2)months].The modified bowel preparation group showed significantly shorter time for single-session bowel preparation[5.4(5.1,6.0)minutes]and fewer enema administrations[1.0(1.0,1.0)times],compared with the conventional bowel preparation group[22.8(15.5,31.4)minutes and 1.5(1.0,2.0)times](P<0.01).No significant difference was observed in the incidence of adverse reactions between the two groups(P>0.05).During enema administration,the modified bowel preparation group reported significantly lower VAS scores for pain[3.0(2.5,3.5)points]and anxiety[3.0(2.0,3.0)points],compared with the conventional bowel preparation group[6.0(5.0,7.0)points and 6.0(5.0,7.0)points](P<0.01).The modified bowel preparation group achieved a significantly higher intraoperative X-ray image quality score[2.0(2.0,3.0)points],compared with the conventional bowel preparation group[1.0(1.0,2.0)points](P<0.01).No significant difference was found in the operative duration between the two groups(P>0.05).The time to first postoperative flatus was significantly shorter in the modified bowel preparation group[3.0(2.0,4.0)hours]than that in the conventional bowel preparation group[8.0(6.0,8.5)hours](P<0.01).No statistically significant differences were observed between the groups regarding the wound condition at 3 and 5 days postoperatively and at 1 week after discharge,or the Majeed functional score at 1 year after discharge(P>0.05).ConclusionFor patients with pelvic fractures treated with percutaneous iliosacral screw fixation,the modified bowel preparation offers advantages over the conventional bowel preparation in terms of simplified procedure,reduced pain and anxiety during enema,improved quality of intraoperative fluoroscopic images,and enhanced recovery of postoperative bowel function.
作者
戴娇
何俊宏
高山
庄云强
张军
汪帅伊
王瑶
杨琼
Dai Jiao;He Junhong;Gao Shan;Zhuang Yunqiang;Zhang Jun;Wang Shuaiyi;Wang Yao;Yang Qiong(Department of Traumatic Orthopedics,Ningbo No.6 Hospital,Ningbo 315040,China;Ningbo Clinical Research Center for Orthopedics,Sports Medicine&Rehabilitation,Ningbo 315040,China;Department of Pharmacy,Ningbo No.6 Hospital,Ningbo 315040,China;Department of Radiology,Ningbo No.6 Hospital,Ningbo 315040,China)
出处
《中华创伤杂志》
北大核心
2025年第12期1213-1219,共7页
Chinese Journal of Trauma
基金
浙江省医药卫生项目(2023KY1150)
宁波市骨科与运动康复临床医学研究中心(2024L004)。
