ABSTRACT
Objective@#To compare the therapeutic effects between the anesthetic and non-anesthetic closed reduction protocols for distal radius fractures based on the concept of Enhanced Recovery After Surgery (ERAS).@*Methods@#A prospective study was conducted in a cohort of 186 patients with distal radius fracture who had been admitted to the Department of Orthopaedic Trauma, Beijing Jishuitan Hospital from September 2018 to January 2019. The patients were divided into 2 groups depending on the choice by themselves. Of them, 72 (intervention group) underwent the standardized closed reduction under brachial block anesthesia based on the concept of ERAS while the other 114 (control group) conventional closed reduction under no anesthesia. The 2 groups were compared in terms of emergency reduction times, swelling scores, reoperation rate, splint removal time, functional outcomes by the Patient-Rated Wrist Evaluation (PRWE) and radiographic outcomes by the Lidström criteria.@*Results@#The patients in both groups were followed up for 6 months. The reduction times were fewer in the intervention group than in the control group (1.1±0.1 versus 1.6±0.1, P<0.05). The reoperation rate was significautly lower in the intervention group than in the control group [2.8%(2/72) versus 12.3%(14/114), P< 0.05]. Reduction deteriorated the swelling condition. Compared with the control group, the swelling was significantly less in the intervention group (2.0±0.1 versus 2.6±0.1, P<0.05). The splint removal time for the intervention group (5.3±0.2 weeks) was significantly shorter than that for the control group (6.9±0.2 weeks) (P<0.05). The intervention group had significantly better PWRE scores than the control group (23.4±1.0 versus 30.3±1.1, P<0.05), but there was no significant difference between groups in the Lidström evaluation (P>0.05).@*Conclusion@#Compared with conventional closed reduction, the closed reduction under anesthesia based on the ERAS concept is an effective method for the emergency treatment of distal radius fracture, because it may minimize the patients’ pain experience, increase the rate of successful reduction, decrease the rate of reoperation, shorten the splint fixation time and gain better functional outcomes.
ABSTRACT
Objective To compare the therapeutic effects between the anesthetic and non-anesthetic closed reduction protocols for distal radius fractures based on the concept of Enhanced Recovery After Surgery (ERAS).Methods A prospective study was conducted in a cohort of 186 patients with distal radius fracture who had been admitted to the Department of Orthopaedic Trauma,Beijing Jishuitan Hospital from September 2018 to January 2019.The patients were divided into 2 groups depending on the choice by themselves.Of them,72 (intervention group) underwent the standardized closed reduction under brachial block anesthesia based on the concept of ERAS while the other 114 (control group) conventional closed reduction under no anesthesia.The 2 groups were compared in terms of emergency reduction times,swelling scores,reoperation rate,splint removal time,functional outcomes by the Patient-Rated Wrist Evaluation (PRWE) and radiographic outcomes by the Lidstr(o)m criteria.Results The patients in both groups were followed up for 6 months.The reduction times were fewer in the intervention group than in the control group (1.1 ± 0.1 versus 1.6 ±0.1,P ＜ 0.05).The reoperation rate was significautly lower in the intervention group than in the control group [2.8％ (2/72) versus 12.3％ (14/114),P ＜0.05].Reduction deteriorated the swelling condition.Compared with the control group,the swelling was significantly less in the intervention group (2.0 ± 0.1 versus 2.6 ±0.1,P ＜ 0.05).The splint removal time for the intervention group (5.3 ±0.2 weeks) was significantly shorter than that for the control group (6.9 ± 0.2 weeks) (P ＜ 0.05).The intervention group had significantly better PWRE scores than the control group (23.4 ± 1.0 versus 30.3 ± 1.1,P ＜ 0.05),but there was no significant difference between groups in the Lidstr(o)m evaluation (P ＞ 0.05).Conclusion Compared with conventional closed reduction,the closed reduction under anesthesia based on the ERAS concept is an effective method for the emergency treatment of distal radius fracture,because it may minimize the patients' pain experience,increase the rate of successful reduction,decrease the rate of reoperation,shorten the splint fixation time and gain better functional outcomes.
ABSTRACT
OBJECTIVE:To observe the clinical efficacy and safety of low molecular heparin in the treatment of cancer-associ-ated acute pulmonary thromboembolism(APTE). METHODS:42 patients with cancer-associated APTE were randomly divided into combination group and simple drug group. All patients were given anti-cancer conventional treatment. Based on it,simple drug group was treated with Low molecular heparin injection 0.1 ml/kg by subcutaneous injection after embolism,q12 h;based on the treatment in simple drug group,combination group was additionally treated with Warfarin sodium tablet initial dose was 3 mg after 1-3 d of treatment,orally,qd. The dosage of warfarin was adjusted based on the international normalized ratio(INR),when INR was 2-3 for continuous 2 days,low molecular heparin was stopped,only warfarin was orally gave. The treatment course was 3 months. The clinic data was observed,including clinical efficacy,and pulmonary arterial blood gas indexes [blood oxygen pressure (pO2)and blood carbon dioxide partial pressure(pCO2)] before and after treatment. The fatality rate,re-embolism rate and bleed-ing rate in 6 months were followed-up,and the incidence of adverse reactions was recorded. RESULTS:The total effective rate in simple drug group was significantly higher than combination group,re-embolism and fatality rate were significantly lower than com-bination group,the differences were statistically significant(P0.05). CONCLU-SIONS:Based on conventional treatment,the low molecular heparin has better efficacy than sequential therapy in the treatment of APTE,with similar safety.