两种固定方法对创伤性尺桡骨骨折术后恢复并发症及成本-效用的影响OACSTPCD

Objective:To explore the application value of intramedullary nailing and plate fixation in the treatment of traumatic distal radius and ulna fractures through postoperative recovery,complications,and cost-effectiveness.Methods:Ninety-two patients with traumatic distal radius and ulna fractures treated in our hospital from April 2021 to March 2023 were randomly divided into two groups:the intramedullary nailing group(n=46)and the plate group(n=46).The intramedullary nailing group underwent internal fixation with interlocking intramedullary nails,while the plate group underwent internal fixation with plates.General conditions of the two groups,fracture healing process,perioperative pain level,and inflammatory stress[C-reactive protein(CRP),interleukin(IL-1β,IL-18),tumor necrosis factor-alpha(TNF-α)]were ob-served.Functional recovery rate,complications,and cost-effectiveness were assessed using Flynn's functional recovery scoring criteria at 6 months postoperatively.Results:The intramedullary nailing group had shorter operation time,incision length,and hospital stay[(74.85±12.47)min,(5.02±1.53)cm,(8.60±2.77)d]compared to the plate group[(86.18±14.00)min,(9.77±1.94)cm,(14.18±4.00)d].The blood loss and drainage volume[(38.59±10.14)ml,(90.03±20.63)ml]were lower than those in the plate group[(120.83±15.67)ml,(151.66±17.94)ml].The intramedullary nailing group had earlier fracture healing time and full weight-bearing time[(8.56±1.49)weeks,(11.29±3.44)weeks]compared to the plate group[(10.08±1.95)weeks,(13.58±4.36)weeks].The bone density ratio at the fracture end at 6 months postoperatively was higher in the intramedullary nailing group(0.89±0.06)than in the plate group(0.86±0.05).The VAS pain scores at 6 h,12 h,48 h,and 72 h postoperatively were lower in the intramed-ullary nailing group[(3.26±0.84),(2.87±0.75),(2.50±0.69),(2.48±0.51)]compared to the plate group[(4.00±0.59),(3.74±0.66),(3.52±0.70),(3.36±0.64)].The CRP levels at 6 h and 72 h postoperatively were lower in the intramedullary nailing group[(15.11±6.00)mg/L,(8.53±1.76)mg/L]compared to the plate group[(18.42±7.03)mg/L,(11.40±2.83)mg/L].IL-1β,IL-18,and TNF-α levels were also lower in the intramedullary nailing group compared to the plate group(all P<0.05).There was no significant difference in the functional recovery rate between the two groups(P>0.05).The cost-ef-fectiveness of intramedullary nailing was superior to plate fixation.Conclusion:Intramedullary nailing for traumatic distal radius and ulna fractures can optimize surgical procedures,reduce intraoperative bleeding,al-leviate perioperative pain,promote postoperative recovery,alleviate patient financial burden,and has good long-term efficacy and safety.