| Background:Nonsteroidal anti-inflammatory drugs(NSAIDs)have been one of the most widely used drugs worldwide for decades,and NSAIDs play an important role in our control of post-traumatic pain.Many studies have come to clear conclusions about the gastrointestinal side effects,nephrotoxicity,and cardiovascular risks of NSAIDs,but the effects of NSAIDs on fracture healing are less well understood.Currently,both animal and in vitro studies have shown impaired bone healing in the presence of NSAIDs,measured by a variety of different parameters.Limited clinical data also support the hypothesis that inhibition of COX-2 by non-selective or COX-2-selective NSAIDs delays fracture healing.Although the underlying mechanisms by which NSAIDs inhibit bone healing in laboratory settings are understood,much of the current knowledge is based on experimental data and retrospective studies,and large-scale controlled trials are needed to answer whether there is a clinically significant similar inhibitory effect.The fracture site used in this study is the clavicle,because the collarbone is a non-weight-bearing bone,and the pain after surgical fixation and immobilization is mild,and most patients can tolerate this degree of pain,which increases the feasibility of the experiment to a certain extent.Objective:This study is to investigate whether the short-term(5 days)use of non-steroidal anti-inflammatory drugs(tromethamine ketorolacinate)has a negative effect on healing after plate fixation of clavicle fractures,and to provide a reference for the clinical research and application of non-steroidal anti-inflammatory drugs.Materials and Methods:A total of 116 patients with allman type I clavicle fracture after internal fixation of steel plate screws admitted to orthopedics from September 2020 to February 2022 were selected as research subjects,and the randomized controlled study was divided into experimental group(58 cases)and control group(58 cases)according to the ratio of 1:1.The experimental group received intravenous bolus of ketorolac tromethamine on the first postoperative day,and the control group received intravenous bolus saline on the first postoperative day,and both groups were used continuously for 5 days.Data from the two groups of patients who were recorded and compared with short-term(5 days)ketorolac tromethamine included:1.Basic information: gender,age,BMI,smoking,alcohol consumption,hypertension,diabetes,coronary heart disease,and cause of injury.2.Postoperative complications: incision infection,steel plate migration,skin irritation,deformity healing.3.Average clinical healing time of fractures: refer to the clinical healing standards of fractures in the ninth edition of "Surgery".4.Imaging score of fracture healing: the Lane-sanhu X-ray scoring standard was used to perform callus formation score and fracture line score for the two groups of patients at 4 weeks,8 weeks and 12 weeks,respectively.5.Clinical efficacy after 12 months of fracture: follow-up was carried out after 12 months of fracture,and the clinical efficacy of patients was evaluated by Constant shoulder score.It is divided into 4 scales: pain(15 points),life function activities(20 points),muscle strength(25 points),and affected shoulder range of motion(40 points).The total score is 100 points,large equal to 90 points are excellent,80 to 89 points are good,60 to 79 points are OK,less than 60 points are poor,the higher the score,the better the function.Results:1.Basic data of the two groups: there were no significant differences between the experimental group and the control group in terms of gender,age,BMI,smoking,drinking,hypertension,diabetes,coronary heart disease,and injury causes(P>0.05).There was no difference in baseline data between the two groups,and the data were balanced and comparable.2.The total incidence of postoperative complications between the two groups: There was no statistical difference between the experimental group and the control group in the total incidence of postoperative complications(P>0.05).3.Average clinical healing time of fractures in the two groups: The difference in the average clinical healing time between the experimental group and the control group was statistically significant(P<0.05),and the average clinical healing time of fractures in the experimental group was higher than that of the control group.4.Calus formation score of the two groups: The overall analysis showed that there were main effects(P<0.05)and time main effects(P<0.001)between groups in the imaging scores of callus formation,and there was no interaction effect between groups and time(P>0.05).The post-hoc comparison of the between-group effect showed that the imaging scores of callus formation between the two groups were statistically significant between groups at 4 and 8 weeks(P<0.05),and not statistically significant between groups at 12 weeks(P>0.05).The post-hoc comparison of time effect showed that there were statistical differences in the imaging scores of callus formation between the experimental group and the control group at 4 weeks,8 weeks and 12 weeks(P<0.05).5.Fracture line scores of the two groups: The overall analysis showed that there were main effects(P<0.05)and time main effects(P<0.001)between groups on fracture line imaging scores,and there was no interaction effect between groups and time(P>0.05).The post-hoc comparison of the between-group effect showed that the fracture line imaging scores of the two groups were statistically significant between groups at 4 and 8 weeks(P<0.05),and not statistically significant between groups at 12 weeks(P>0.05).The post-hoc comparison of time effect showed that there were statistical differences in the fracture line imaging scores between the experimental group and the control group at 4 weeks,8 weeks and 12 weeks(P<0.05).6.Clinical efficacy of fractures in the two groups after12 months: There was no significant difference in the Constant shoulder score between the experimental group and the control group after 12 months of fracture(P>0.05).Conclusion:1.The use of ketochromate tromethamine has no effect on the overall incidence of postoperative complications in patients with clavicle fracture.2.Tromethamine ketochromate has an adverse effect on postoperative healing in patients with clavicle fracture,which is specifically manifested as delaying the process of fracture healing and is a potential risk factor for fracture healing.3.The negative effect of tromethamine ketochromate on postoperative healing in patients with clavicle fracture is mainly in the early stage,but this effect is reversible.4.The use of tromethamine ketochromate has no effect on the long-term functional recovery of patients with clavicle fracture after surgery. |
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