目的探讨高压氧辅助治疗高能量下肢骨折的效果。
方法本研究为前瞻性病例对照研究。筛选2021年1月至2022年12月期间首都医科大学附属北京潞河医院骨中心收治的高能量下肢骨折患者，骨折类型包括胫骨平台骨折、pilon骨折、踝关节骨折伴脱位及跟骨骨折。采用随机数表法将患者随机分为对照组（接受骨科常规治疗）和试验组（除接受骨科常规治疗外，围手术期还增加高压氧治疗：在伤后48 h内进行第一次高压氧治疗）。随访至术后1年，比较两组患者的术后早期和晚期伤口并发症发生率、入院至手术时间及住院时间。
结果本研究共纳入160例高能量下肢骨折患者，7例出组，最终试验组72例、对照组81例患者完成研究。试验组男48例，女24例；年龄（46.3±12.5)岁。对照组男61例，女20例；年龄（47.8±13.4岁）。两组患者治疗前一般资料比较差异均无统计学意义（ P>0.05），具有可比性。试验组患者早期伤口并发症发生率为5.6%（4/72），显著低于对照组患者[18.5%（15/81）]，差异有统计学意义（ P<0.05）。试验组和对照组患者晚期伤口并发症发生率分别为12.5%（9/72）、9.9%（8/81），差异无统计学意义（ P>0.05）。试验组和对照组患者的入院至手术时间分别为4（2,8）、4（2,6）d，住院时间分别为10（7,14）、9（6,12）d，两组比较差异均无统计学意义（ P > 0.05）。
结论在高能量下肢骨折的治疗中，围手术期辅助高压氧治疗可降低早期伤口并发症的发生率且不增加患者的住院时间，但未能降低晚期伤口并发症发生率，也不能缩短术前等待时间。
ObjectiveTo explore the effects of adjuvant therapy by hyperbaric oxygen for high-energy lower limb fractures.
MethodsThis prospective case-control study enrolled the patients with high-energy lower extremity fracture who had been admitted to Department of Orthopaedics, Beijing Luhe Hospital, Capital Medical University from January 2021 to December 2022. Their fracture types included tibial plateau ones, pilon ones, ankle ones complicated with dislocation, and calcaneal ones. The patients were randomly divided into a control group receiving routine orthopedic treatment and a trial group receiving adjuvant therapy by hyperbaric oxygen in addition to routine orthopedic treatment using a random number table. The first adjuvant therapy by hyperbaric oxygen was conducted in the trial group within 48 h after injury before the timing for surgery was decided according to the soft tissue swelling at the affected limb. Follow-up was conducted until one year after surgery. The early and late wound complications, time from injury to surgery, and hospital stay were compared between the 2 groups.
ResultsA total of 160 patients with high-energy lower extremity fracture were enrolled in this study. Eventually, 7 patients were excluded, 72 patients [48 males and 24 females, with an age of (46.3±12.5) years] included in the trial group and 81 patients [61 males and 20 females, with an age of (47.8±13.4) years] in the control group. There was no significant difference in the preoperative general data between the 2 groups, indicating comparability ( P>0.05). The incidence of early wound complications in the trial group was 5.6% (4/72), significantly lower than that in the control group [18.5% (15/81)] ( P<0.05). The incidences of late wound complications in the trial and control groups were 12.5% (9/72) and 9.9% (8/81) respectively, showing no statistically significant difference ( P>0.05). The time from admission to surgery was respectively 4 (2, 8) days and 4 (2, 6) days, and the hospital stay respectively 10 (7, 14) days and 9 (6, 12) days for the trial and control groups, showing no statistically significant differences between the 2 groups ( P>0.05).
ConclusionIn the treatment of high-energy lower extremity fractures, adjuvant therapy by hyperbaric oxygen can reduce the incidence of early wound complications without increasing the hospital stay, but it does not reduce the incidence of late wound complications or shorten the preoperative waiting time.
汪雄飞,李亚娟,董文硕,等. 高压氧辅助治疗高能量下肢骨折的随机对照研究[J]. 中华创伤骨科杂志,2025,27(03)：222-227.
DOI:10.3760/cma.j.cn115530-20241226-00508版权归中华医学会所有。
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除非特别声明，本刊刊出的所有文章不代表中华医学会和本刊编委会的观点。
汪雄飞：招募入组、数据收集及整理、统计学分析、论文撰写、论文修改；李亚娟、董文硕：高压氧治疗、数据收集；刘亮：研究指导；张亚奎：研究指导、手术操作；龙安华：研究设计及指导、手术操作、论文修改
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