地塞米松罗哌卡因预防跟骨骨折切口并发症△

Dexamethasone and ropivacaine for prevention of incision complications of open reduction and internal fixation of calcaneal fractures

摘要:

[目的] 探讨术中局部注射地塞米松联合罗哌卡因（dexamethasone ropivacaine, DR） 预防跟骨骨折切口相关并发症的疗效。[方法] 回顾性分析本院2019 年1 月—2022 年10 月开放复位内固定治疗跟骨骨折136 例（137 足） 的临床资料。根据医患沟通结果，68 例（68 足） 术中切口周围注射DR（DR 组），68 例（69 足） 未注射DR（常规组）。比较两组围手术期资料。[结果] 两组患者手术时间、切口长度、术中失血量的差异均无统计学意义（P＞0.05）。DR 组在术后切口肿胀时间[(4.7±1.1) d vs (6.8±2.9) d, P＜0.001]、渗出时间[(3.6±1.6) d vs (6.4±1.2) d, P＜0.001]、术后住院时间[(7.3±1.2) d vs (8.5±2.1) d, P＜0.001] 及术后VAS 评分[术后1 d, (5.2±1.2) vs (8.4±1.1), P＜0.001; 术后2 d, (4.8±1.3) vs (6.6±1.8), P＜0.001; 术后3 d, (3.4±1.8) vs (4.3±1.6) , P＜0.001] 均显著优于常规组，DR 组切口愈合等级显著优于常规组[甲/乙/丙, (66/0/2) vs (58/2/9), P=0.010]，两组患者术后拆线时间的差异无统计学意义（P＞0.05）。[结论] 术中切口周围局部注射地塞米松联合罗哌卡因能有效减轻跟骨骨折患者术后疼痛，减少切口相关并发症的发生。

Abstract:

[Objective] To investigate the efficacy of local injection of dexamethasone combined with ropivacaine (DR) in the preven-tion of incision-related complications of open reduction and internal fixation (ORIF) of calcaneal fractures. [Methods] A retrospectivestudy was conducted on 136 patients (137 feet) who underwent ORIF for calcaneal fractures in our hospital from January 2019 to October2022. According to doctor-patient communication, 68 patients (68 feet) received intraoperative DR injection around the incision (the DRgroup), while the other 68 patients (69 feet) had no DR injected (the routine group). The perioperative data of the two groups were compared.[Results] Although there were no significant differences in operation time, incision length and intraoperative blood loss between the twogroups (P＞0.05), the DR group proved significantly superior to the routine group in terms of incision swelling time [(4.7±1.1) days vs (6.8±2.9) days, P＜0.001], exudation time [(3.6±1.6) days vs (6.4±1.2) days, P＜0.001], postoperative hospitalization time [(7.3±1.2) days vs (8.5±2.1) days, P＜0.001] and postoperative pain VAS score [1 day postoperatively, (5.2±1.2) vs (8.4±1.1), P＜0.001; 2 days postoperatively, (4.8±1.3) vs (6.6±1.8), P＜0.001; 3 days postoperatively, (3.4±1.8) vs (4.3±1.6), P＜0.001]. In addition, the former was significantly better than thelatter in incision healing grade [A/B/C, (66/0/2) vs (58/2/9), P=0.010], howerve, there was no statistically significant difference in postopera-tive stitches removal time between the two groups (P＞0.05). [Conclusion] Local injection of dexamethasone combined with ropivacainearound the incision does effectively reduce postoperative pain and incision-related complications in ORIF of calcaneal fracture.