选择性COX-2抑制剂与传统非甾体类抗炎药预防肘关节骨折术后异位骨化的疗效比较

发布时间：2018-08-06 17:48

【摘要】：目的本课题旨在观察肘关节周围骨折术后选择性COX-2抑制剂塞来昔布和传统的非选择性NSAIDS药物吲哚美辛预防异位骨化的疗效比较。方法取得我院2014年-2016年我科收治的肘关节骨折患者的资料,所有手术均由同一组医师所做,手术后第一天所有患者均开始患侧肘关节主动康复锻炼,并辅助以口服吲哚美辛或塞来昔布,在镇痛的同时预防异位骨化。经过筛选和排除后,总共57例患者纳入本次研究。根据预防异位骨化发生的口服药物的不同,分为塞来昔布组24例、吲哚美辛组33例。均为术后第一天开始用药,2周后停药,塞来昔布的用药方式为200mg,每日1次;吲哚美辛为25mg,每日3次。随访时间为术后4周、3月、6月和1年,通过摄患侧肘关节X线观察患者的骨折愈合情况和异位骨化发生情况。最后1次随访,根据两组患者的肘关节X线表现、Mayo肘关节功能评分及肘关节活动度对其进行疗效评估和对比。结果塞来昔布组发生异位骨化4列,根据Hastings-Graham分型:I型2例,IIA型1例,IIC型1例;吲哚美辛组发生异位骨化3例,I型1例,IIA型1例,IIC型1例。两组患者的最终的异位骨化发生率分别是16.7%、9%,比较无明显差异(P0.05)。两组患者最终Mayo肘关节功能评分的平均分分别为(89.1±8.7)分和(89.7±7.7)分,差别无统计学意义(P0.05)。两组患者的最终肘关节活动度分别为(108.5±11.9°)和(106.8±12.1°),统计学上无明显差异。两组患者术后2周,统计塞来昔布组有2例患者出现上腹部不适,但用餐后症状明显减轻,均未停药;吲哚美辛组有10例患者出现胃肠道不适,其中有3例因消化道反应严重而停药,两组患者的胃肠道毒性不良反应的总发生率分别是8.3%、30.3%,差异有统计学意义(P0.05)。结论塞来昔布在预防肘关节骨折术后异位骨化的作用与吲哚美辛效用相当,但考虑到非选择性NSAIDs药对患者胃肠道不良反应,笔者认为在预防肘关节骨折术后异位骨化的治疗中,短期应用塞来昔布可能是一种有效而且安全的选择。
[Abstract]:Objective to compare the effects of celecoxib, a selective COX-2 inhibitor, and indomethacin, a traditional nonselective NSAIDS drug, on the prevention of ectopic ossification after operation of peri-elbow fractures. Methods the data of the patients with elbow fracture admitted in our hospital from 2014 to 2016 were obtained. All the operations were performed by the same group of doctors. On the first day after operation, all the patients began active rehabilitation exercise of the affected elbow joint. Oral indomethacin or celecoxib was added to prevent ectopic ossification while analgesia. After screening and exclusion, a total of 57 patients were included in the study. According to the different oral drugs to prevent ectopic ossification, they were divided into celecoxib group (n = 24) and indomethacin group (n = 33). Celecoxib was used once a day, and indomethacin was 25 mg, 3 times a day. The patients were followed up for 4 weeks, 3 months, 6 months and 1 year. Fracture healing and ectopic ossification were observed by X ray of the affected side of elbow joint. At the last follow-up, the curative effect was evaluated and compared according to the function score of elbow joint and the range of motion of elbow joint in the two groups according to the X ray findings of elbow joint. Results ectopic ossification occurred in 4 columns in celecoxib group. According to Hastings-Graham classification, 1 case of IIA type and 3 cases of ectopic ossification occurred in indomethacin group according to Hastings-Graham classification. The incidence of ectopic ossification in the two groups was 16.7and 9.There was no significant difference between the two groups (P0.05). The final Mayo elbow function scores of the two groups were (89.1 卤8.7) and (89.7 卤7.7), respectively. The difference was not statistically significant (P0.05). The final elbow motion of the two groups was (108.5 卤11.9 掳) and (106.8 卤12.1 掳) respectively, and there was no significant difference between the two groups. Two weeks after operation, 2 patients in the celecoxib group had epigastric discomfort, but the symptoms were obviously alleviated after meal, and none of the patients stopped taking the medicine, while in the indomethacin group, 10 patients had gastrointestinal discomfort. Among them, 3 cases were stopped because of serious gastrointestinal reaction. The total incidence of gastrointestinal toxicity in the two groups was 8.3% and 30.3, respectively. The difference was statistically significant (P0.05). Conclusion the effect of celecoxib on the prevention of ectopic ossification after elbow fracture is similar to that of indomethacin. However, considering the adverse effects of non-selective NSAIDs on gastrointestinal tract, the author believes that the prevention of heterotopic ossification after elbow joint fracture should be taken into account in the treatment of ectopic ossification. Short-term use of celecoxib may be an effective and safe option.
【学位授予单位】：山西医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R687.3

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