非甾体类抗炎药对桡骨远端骨折手术修复后愈合率的影响。
The Effect of Nonsteroidal Anti-Inflammatory Drugs on Union Rates Following Operative Repair of Distal Radius Fractures.
作者信息
Chang Michael, Kasper Alexis, Chung Juliet, Wright Justin, Pennington Margaret, Ilyas Asif M
机构信息
Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA.
Pennsylvania State University College of Medicine, Hershey, PA.
出版信息
J Hand Surg Glob Online. 2025 May 21;7(4):100720. doi: 10.1016/j.jhsg.2025.03.001. eCollection 2025 Jul.
PURPOSE
Multimodal pain regimens for controlling postoperative pain after surgery for fractures often include nonsteroidal anti-inflammatory drugs (NSAIDs). However, some surgeons remain reluctant toward prescribing NSAIDs because of concerns of compromised bone healing. The study hypothesis was that a short-term prescription of NSAIDs for postoperative pain after distal radius fracture repair would not result in a significant difference in union rates.
METHODS
Consecutive patients who underwent surgical repair of a distal radius fracture with a volar locking plate from a single academic institution with five hand surgery fellowship-trained orthopedic surgeons were retrospectively reviewed. The cohort was divided into those prescribed +NSAIDs and those who were not (-NSAIDs) postoperatively. Preoperative patient characteristics and postoperative pain regimens were recorded. Comparisons between the two groups were made based on the primary outcome being union rate and other secondary outcomes, including time to union and number of opioid tablets prescribed.
RESULTS
Four hundred and ninety-four patients were included in the final analysis, of which 115 were prescribed +NSAIDs, and 379 were not (-NSAIDs). Preoperative demographics and comorbidities were balanced between groups. A similar proportion of patients were prescribed some type of opioid. However, the +NSAIDs group was prescribed a fewer number of opioid tablets. The overall nonunion rate was 1.2%. Of these cases, two were in the +NSAIDs group, and four were in the -NSAIDs group. There was no difference in union rate between the two groups.
CONCLUSIONS
The prescribing of NSAIDs after volar locking plate fixation of distal radius fractures was not associated with an increased nonunion rate in this study. This study may alleviate concerns that NSAIDs might jeopardize fracture healing when used postoperatively as part of a multimodal pain regimen following distal radius fracture repair.
TYPE OF STUDY/LEVEL OF EVIDENCE: Prognostic IV.
目的
用于控制骨折手术后疼痛的多模式镇痛方案通常包括非甾体类抗炎药（NSAIDs）。然而，由于担心影响骨愈合，一些外科医生仍不愿开具NSAIDs处方。本研究的假设是，短期使用NSAIDs治疗桡骨远端骨折修复术后疼痛不会导致骨折愈合率出现显著差异。
方法
对来自单一学术机构的连续患者进行回顾性研究，这些患者均接受了由五位接受过手外科专科培训的骨科医生使用掌侧锁定钢板进行的桡骨远端骨折手术修复。将该队列分为术后开具NSAIDs处方的患者（+NSAIDs组）和未开具NSAIDs处方的患者（-NSAIDs组）。记录术前患者特征和术后镇痛方案。两组之间的比较基于主要结局即骨折愈合率以及其他次要结局，包括愈合时间和开具的阿片类药物片数。
结果
494例患者纳入最终分析，其中115例患者术后开具了NSAIDs处方（+NSAIDs组），379例未开具（-NSAIDs组）。两组术前人口统计学和合并症情况均衡。开具某种阿片类药物的患者比例相似。然而，+NSAIDs组开具的阿片类药物片数较少。总体不愈合率为1.2%。其中，+NSAIDs组有2例，-NSAIDs组有4例。两组之间的骨折愈合率无差异。
结论
本研究中，桡骨远端骨折掌侧锁定钢板固定术后开具NSAIDs处方与不愈合率增加无关。本研究可能会减轻人们对于在桡骨远端骨折修复术后将NSAIDs作为多模式镇痛方案的一部分使用时可能会危及骨折愈合的担忧。
研究类型/证据水平：预后性IV级。
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