不同剂量玻璃酸钠辅助手术治疗对胫骨平台骨折术后恢复与应激状态的影响

摘要

目的 探讨不同剂量玻璃酸钠辅助手术治疗对胫骨平台骨折术后恢复与应激状态的影响.方法 选取2010年1月至2016年12月收入涟水县人民医院的96例胫骨平台骨折患者为研究对象,根据随机数表法分为对照组和研究组A、研究组B,各32例.对照组接受单纯手术治疗;研究组A予以低剂量玻璃酸钠关节腔内注射辅助手术治疗(20 mg);研究组B予以高剂量玻璃酸钠关节腔内注射辅助手术治疗(25 mg).比较各组患者术后的疼痛评分、膝关节活动度和手术前后的疼痛应激、氧化应激、炎性应激等指标.结果 术后3 d,研究组A、研究组B、对照组患者的疼痛评分分别为(4.62±0.90)分、(3.31±0.81)分和(5.75±1.16)分,研究组B低于研究组A,研究组A低于对照组,组间比较差异均有统计学意义(P<0.05);同时,术后7 d,研究组A、研究组B、对照组的疼痛评分分别为(1.97±0.62)分、(1.08±0.53)分和(2.98±0.66)分,研究组A和研究组B均低于对照组,差异均有统计学意义(P<0.05);治疗1周后,研究组A、研究组B、对照组膝关节活动度分别为(49.45±6.17)分、(54.24±6.55)分和(42.38±5.32)分,研究组B膝关节活动度优于研究组A,研究组A优于对照组,差异均有统计学意义(P<0.05);治疗4周后,研究组A、研究组B、对照组膝关节活动度分别为(88.12±7.23)分、(104.17±7.24)分和(70.14±6.79),研究组B膝关节活动度明显优于研究组A,研究组A优于对照组,差异均有统计学意义(P<0.05).术前三组患者的血清前列腺素(PGE2)、神经肽Y(NPY)、P物质(SP)比较差异无统计学意义(P>0.05);术后3 d,研究组A,研究组B和对照组的PGE2分别为(165.53±14.47)pg/mL、(141.56±12.69)pg/mL和(183.34±14.24)pg/mL;NPY分别为(200.57±20.33)pg/mL、(184.36±18.61)pg/mL和(223.54±21.25)pg/mL;SP分别为(7.15±0.89)μg/mL、(6.07±0.81)μg/mL和(9.68±1.07)μg/mL,研究组B低于研究组A,研究组A低于对照组,差异均有统计学意义(P<0.05);术后7 d,研究组A,研究组B和对照组的PGE2分别为(136.58±13.19)pg/mL、(117.43±11.66)pg/mL和162.16±13.35)pg/mL;NPY分别为(181.23±17.96)pg/mL、(158.55±15.74)pg/mL和(201.27±18.11)pg/mL;SP分别为(5.72±0.71)μg/mL、(4.03±0.54)μg/mL和(7.53±1.03)μg/mL,研究组B低于研究组A,研究组A低于对照组,差异均有统计学意义(P<0.05).结论 高剂量的玻璃酸钠关节腔内注射辅助手术治疗能够有效缓解胫骨平台骨折患者围术期疼痛,促进膝关节功能康复,提高关节活动度防止僵硬及粘连,改善机体综合应激状态,值得临床上推广应用.%Objective To explore the influence of operative treatment assisted by intraarticular injection of dif-ferent doses of sodium hyaluronate on the postoperative rehabilitation and comprehensive stress state of patients with tib-ial plateau fracture during the perioperative period. Methods A total of 96 cases of patients with tibial plateau fracture,who admitted to Lianshui People's Hospital from January 2010 to December 2016, were selected and divided into the control group, the observation group A and the observation group B according to random number table, with 32 cases in each group. The control group received the operative treatment, and the observation group A and group B were given in-jection of 20 mg, 25 mg sodium hyaluronate on the basis of the control group, respectively. The visual analog scale (VAS) score, knee joint range of motion, the pain tress, inflammatory stress and oxidative stress indexes among the three groups before and after the treatment were analyzed and compared. Results The VAS scores of the observation group A, the observation group B and the control group were (4.62±0.90), (3.31±0.81), (5.75±1.16) three days after the opera-tion and (1.97 ± 0.62), (1.08 ± 0.53), (2.98 ± 0.66) seven days after the operation, respectively, with the differences among the three groups statistically significant (P<0.05). The knee joint range of motion of the observation group A, the obser-vation group B and the control group (49.45±6.17), (54.24±6.55), (42.38±5.32) one week after the operation and (88.12± 7.23), (104.17 ± 7.24), (70.14 ± 6.79) four weeks after the operation, respectively, and the differences among the three groups were statistically significant (P<0.05). PGE2, NPY, SP showed no significant difference among the three groups before the operation (P>0.05), but they had significant difference among the three groups 3 d after operation and 7 d after operation (P<0.05):3 d after operation:(165.53±14.47) pg/mL, (141.56±12.69) pg/mL, (183.34±14.24) pg/mL for PGE2, (200.57±20.33) pg/mL, (184.36±18.61) pg/mL, (223.54±21.25) pg/mL for NPY, (7.15±0.89)μg/mL, (6.07± 0.81)μg/mL, ( 9.68 ± 1.07)μg/mL for SP;7 d after operation:(136.58 ± 13.19) pg/mL, (117.43 ± 11.66) pg/mL, (162.16 ± 13.35) pg/mL for PGE2, (181.23±17.96) pg/mL, (158.55±15.74) pg/mL, (201.27±18.11) pg/mL for NPY, (5.72±0.71)μg/mL, (4.03 ± 0.54)μg/mL, (7.53 ± 1.03)μg/mL for SP. Conclusion The injection of high doses of sodium hyaluronate com-bined with operative treatment can relieve perioperative pain effectively for the patients with tibial plateau fracture, sig-nificantly improve the patients'postoperative rehabilitation and body comprehensive stress state, and decrease the inci-dence of anchylosis and knee arthrofibrosis. It's worthy of clinical promotion.