選擇性COX-2抑制劑與傳統(tǒng)非甾體類抗炎藥預(yù)防肘關(guān)節(jié)骨折術(shù)后異位骨化的療效比較
發(fā)布時間：2018-08-06 17:48
【摘要】：目的本課題旨在觀察肘關(guān)節(jié)周圍骨折術(shù)后選擇性COX-2抑制劑塞來昔布和傳統(tǒng)的非選擇性NSAIDS藥物吲哚美辛預(yù)防異位骨化的療效比較。方法取得我院2014年-2016年我科收治的肘關(guān)節(jié)骨折患者的資料,所有手術(shù)均由同一組醫(yī)師所做,手術(shù)后第一天所有患者均開始患側(cè)肘關(guān)節(jié)主動康復(fù)鍛煉,并輔助以口服吲哚美辛或塞來昔布,在鎮(zhèn)痛的同時預(yù)防異位骨化。經(jīng)過篩選和排除后,總共57例患者納入本次研究。根據(jù)預(yù)防異位骨化發(fā)生的口服藥物的不同,分為塞來昔布組24例、吲哚美辛組33例。均為術(shù)后第一天開始用藥,2周后停藥,塞來昔布的用藥方式為200mg,每日1次;吲哚美辛為25mg,每日3次。隨訪時間為術(shù)后4周、3月、6月和1年,通過攝患側(cè)肘關(guān)節(jié)X線觀察患者的骨折愈合情況和異位骨化發(fā)生情況。最后1次隨訪,根據(jù)兩組患者的肘關(guān)節(jié)X線表現(xiàn)、Mayo肘關(guān)節(jié)功能評分及肘關(guān)節(jié)活動度對其進行療效評估和對比。結(jié)果塞來昔布組發(fā)生異位骨化4列,根據(jù)Hastings-Graham分型:I型2例,IIA型1例,IIC型1例;吲哚美辛組發(fā)生異位骨化3例,I型1例,IIA型1例,IIC型1例。兩組患者的最終的異位骨化發(fā)生率分別是16.7%、9%,比較無明顯差異(P0.05)。兩組患者最終Mayo肘關(guān)節(jié)功能評分的平均分分別為(89.1±8.7)分和(89.7±7.7)分,差別無統(tǒng)計學(xué)意義(P0.05)。兩組患者的最終肘關(guān)節(jié)活動度分別為(108.5±11.9°)和(106.8±12.1°),統(tǒng)計學(xué)上無明顯差異。兩組患者術(shù)后2周,統(tǒng)計塞來昔布組有2例患者出現(xiàn)上腹部不適,但用餐后癥狀明顯減輕,均未停藥;吲哚美辛組有10例患者出現(xiàn)胃腸道不適,其中有3例因消化道反應(yīng)嚴重而停藥,兩組患者的胃腸道毒性不良反應(yīng)的總發(fā)生率分別是8.3%、30.3%,差異有統(tǒng)計學(xué)意義(P0.05)。結(jié)論塞來昔布在預(yù)防肘關(guān)節(jié)骨折術(shù)后異位骨化的作用與吲哚美辛效用相當(dāng),但考慮到非選擇性NSAIDs藥對患者胃腸道不良反應(yīng),筆者認為在預(yù)防肘關(guān)節(jié)骨折術(shù)后異位骨化的治療中,短期應(yīng)用塞來昔布可能是一種有效而且安全的選擇。
[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 鹵8.7) and (89.7 鹵7.7), respectively. The difference was not statistically significant (P0.05). The final elbow motion of the two groups was (108.5 鹵11.9 擄) and (106.8 鹵12.1 擄) 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.
【學(xué)位授予單位】：山西醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R687.3
本文編號：2168507
[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 鹵8.7) and (89.7 鹵7.7), respectively. The difference was not statistically significant (P0.05). The final elbow motion of the two groups was (108.5 鹵11.9 擄) and (106.8 鹵12.1 擄) 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.
【學(xué)位授予單位】：山西醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R687.3
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