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Clinical Application and Effects of Sodium Hyaluronate-Carboxymethylcellulose (Guardix®) in Surgery of Ankle Fractures

족관절 골절 수술에서의 유착방지제(Guardix®)의 효과 연구

  • Kim, Gab Lae (Department of Orthopaedic Surgery, Kangdong Sacred Heart Hospital, Hallym University College of Medicine) ;
  • Kwon, Hwan Jin (Department of Orthopaedic Surgery, Kangdong Sacred Heart Hospital, Hallym University College of Medicine)
  • 김갑래 (한림대학교 의과대학 강동성심병원 정형외과학교실) ;
  • 권환진 (한림대학교 의과대학 강동성심병원 정형외과학교실)
  • Received : 2017.10.17
  • Accepted : 2017.10.30
  • Published : 2017.12.15

Abstract

Purpose: Reducing tenderness or pain on the ankle joint and improving the range of motion are thought to be possible using hyaluronate-based anti-adhesive agents. On the other hand, there are more aspects to be studied regarding the incidence of complications, such as resting pain, tenderness, and stiffness, after surgery. Therefore, the aim of this study was to prove the effectiveness of the agents after ankle fracture surgery. Materials and Methods: Patients, who underwent open reduction and internal fixation surgery due to ankle joint fractures from June 2015 to May 2016, were studied prospectively. Thirty patients of them received a $Guardix^{(R)}$ injection during their surgeries and were included in the injection group. The other 30 patients were included in the control group. Postoperatively, tenderness on the scar, a delay in wound healing, and the active range of motion were evaluated at 2, 6, and 12 weeks after surgery. Results: A significant difference in tenderness on the scar was observed 2 weeks after surgery. On the other hand, there was no significant difference at 6 and 12 weeks after the surgery. The agent-using group showed a 6.7% delay in wound healing and a 93.3% nondelaying. In the non-using group, the delay was 63.3%, while non-delay was 36.7% (p<0.001). The group that underwent $Guardix^{(R)}$ usage showed an effective result in the visual analogue scale, which was statistically significant (p<0.001). The result at 6 and 12 weeks after surgery showed a significant difference. Conclusion: Improvement was observed in the patients who underwent a $Guardix^{(R)}$ injection, regarding the range of motion, visual analog scale, and healing of the wound postoperatively.

Keywords

References

  1. Cimino W, Ichtertz D, Slabaugh P. Early mobilization of ankle fractures after open reduction and internal fixation. Clin Orthop Relat Res. 1991;(267):152-6.
  2. Finsen V, Saetermo R, Kibsgaard L, Farran K, Engebretsen L, Bolz KD, et al. Early postoperative weight-bearing and muscle activity in patients who have a fracture of the ankle. J Bone Joint Surg Am. 1989;71:23-7. https://doi.org/10.2106/00004623-198971010-00005
  3. Burwell HN, Charnley AD. The treatment of displaced fractures at the ankle by rigid internal fixation and early joint movement. J Bone Joint Surg Br. 1965;47:634-60.
  4. Song HJ, Kim JW, Park JS, Kim YS, Choi YS, Kim BG, et al. Effects of three different types of anti-adhesive agents in a rat abdominal wall defect model. J Korean Surg Soc. 2009;77:7-14. https://doi.org/10.4174/jkss.2009.77.1.7
  5. Dijkstra FR, Nieuwenhuijzen M, Reijnen MM, van Goor H. Recent clinical developments in pathophysiology, epidemiology, diagnosis and treatment of intra-abdominal adhesions. Scand J Gastroenterol Suppl. 2000;(232):52-9.
  6. Rout UK, Diamond MP. Role of plasminogen activators during healing after uterine serosal lesioning in the rat. Fertil Steril. 2003;79:138-45. https://doi.org/10.1016/S0015-0282(02)04569-7
  7. Holmdahl L, Ivarsson ML. The role of cytokines, coagulation, and fibrinolysis in peritoneal tissue repair. Eur J Surg. 1999;165:1012-9. https://doi.org/10.1080/110241599750007810
  8. Herrick SE, Mutsaers SE, Ozua P, Sulaiman H, Omer A, Boulos P, et al. Human peritoneal adhesions are highly cellular, innervated, and vascularized. J Pathol. 2000;192:67-72. https://doi.org/10.1002/1096-9896(2000)9999:9999<::AID-PATH678>3.0.CO;2-E
  9. Kim JH, Lee JH, Yoon JH, Chang JH, Bae JH, Kim KS. Antiadhesive effect of the mixed solution of sodium hyaluronate and sodium carboxymethylcellulose after endoscopic sinus surgery. Am J Rhinol. 2007;21:95-9. https://doi.org/10.2500/ajr.2007.21.2911
  10. Ellis H, Moran BJ, Thompson JN, Parker MC, Wilson MS, Menzies D, et al. Adhesion-related hospital readmissions after abdominal and pelvic surgery: a retrospective cohort study. Lancet. 1999;353:1476-80. https://doi.org/10.1016/S0140-6736(98)09337-4
  11. Lower AM, Hawthorn RJ, Ellis H, O'Brien F, Buchan S, Crowe AM. The impact of adhesions on hospital readmissions over ten years after 8849 open gynaecological operations: an assessment from the Surgical and Clinical Adhesions Research Study. BJOG. 2000;107:855-62. https://doi.org/10.1111/j.1471-0528.2000.tb11083.x
  12. Shim HS, Lee YW, Lee YM, Oh YH, Kwon SW, Kim JH, et al. Evaluation of resorbable materials for preventing surgical adhesion on rat experiment. J Korean Surg Soc. 2002;63:179-86.
  13. Hooker GD, Taylor BM, Driman DK. Prevention of adhesion formation with use of sodium hyaluronate-based bioresorbable membrane in a rat model of ventral hernia repair with polypropylene mesh--a randomized, controlled study. Surgery. 1999;125:211-6. https://doi.org/10.1016/S0039-6060(99)70267-9
  14. Wisniewski HG, Vilcek J. TSG-6: an IL-1/TNF-inducible protein with anti-inflammatory activity. Cytokine Growth Factor Rev. 1997;8:143-56. https://doi.org/10.1016/S1359-6101(97)00008-7