气囊止血带在胫腓骨下段骨折手术中的使用

目的:探讨止血带在胫腓骨下段骨折临床应用中存在诸多并发症,术中是否常规应用。方法:回顾性分析2018年6月至2019年9月采用钢板螺钉治疗闭合性胫腓骨下段骨折(AO分型43A型)33例,按是否应用气囊止血带分成两组:观察组16例,男13例,女3例,年龄18～69(38.8±17.0)岁,伤后手术时间(6.9±1.7) d,手术中不应用止血带;对照组17例,男13例,女4例,年龄21～71(43.8±12.4)岁,伤后手术时间(6.5±1.0) d,手术中常规应用自动气压止血带。比较两组患者的手术时间、失血量、术后肿胀、疼痛及并发症情况。结果:33例患者获得随访,时间12～20个月,平均15个月,两组患者的手术时间和失血量比较,差异均无统计学意义(P0.05);观察组患者术后1、3 d,肢体疼痛视觉模拟评分(visual analogue scale,VAS)分别为(5.13±1.70)分、(2.25±1.60)分,明显低于对照组的(7.35±1.30)分、(4.18±1.60)分;肿胀分别为(3.67±0.70) cm、(2.02±0.90) cm,明显低于对照组的(4.54±0.40) cm、(3.54±0.40) cm(P0.05);对照组存在止血带疼痛1例、麻木1例、水泡1例及切口愈合不良1例,观察组无此类并发症,差异有统计学意义(P0.05)。结论:胫腓骨下段骨折位置表浅,术中容易暴露及固定,为避免止血带并发症,术中不建议常规使用气囊止血带或尽量减少止血带应用时间。

Application of pueumatic tourniquet in the operation of lower tibiofibular fracture

Objective: To investigate the complications of tourniquet in the clinical application of lower tibiofibular fracture.Methods: From June 2018 to September 2019,33 cases of closed lower tibiofibular fractures(AO type 43A) were treated with plates and screws and were divided into two groups according to whether pueumatic tourniquet was used:16 cases in the observation group,13 males and 3 females,aged 18 to 69(38.8±17.0) years,the operation time after injury was (6.9±1.7) days,and tourniquet was not used during operation. There were 17 cases in the control group,13 males and 4 females,aged from 21 to 71 (43.8±12.4) years,the operation time after injury was (6.5±1.0) days,automatic pneumatic tourniquet was routinely used in the operation. The operation time,blood loss,postoperative swelling,pain and other complications were compared between two groups.Results: Total of 33 patients were followed up for an average of 15 months. There was no significant difference in operation time and blood loss between two groups (P>0.05). The VAS scores of limb pain in the observation group were 5.13±1.70 and 2.25±1.60 respectively 1 and 3 days after operation,which were significantly lower than those in the control group 7.35±1.30 and 4.18±1.60;the swelling was (3.67±0.70) cm and (2.02±0.90) cm respectively,which was significantly lower than(4.54±0.40) cm and(3.54±0.40) cm in the control group (P<0.05);there were 1 case of tourniquet pain,1 case of numbness,1 case of blister and 1 case of poor wound healing in the control group,there were no such complications in the observation group(P<0.05).Conclusion: The fracture of lower tibiofibular segment is superficial and easy to be exposed and fixed during operation. In order to avoid tourniquet complications,it is not recommended to use air bag tourniquet routinely or minimize the application time of tourniquet.