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《中醫(yī)正骨》[ISSN:1001-6015/CN:41-1162/R]

卷:

第25卷

期數(shù):

2013年07期

頁(yè)碼:

16-19

欄目:

臨床研究

出版日期:

2013-07-31

文章信息/Info

Title:

A randomized controlled trial of manipulative reduction combined with external fixation using splint over metacarpophalangeal joint and splint over wrist joint in turn for the treatment of distal radius fractures

作者:

董森; 陳祖平; 李輝

福建省寧德市中醫(yī)院,福建 寧德 352100

Author(s):

DONG Sen^*; CHEN Zu-ping; LI Hui.^*

Traditional Chinese Medicine Hospital of Ningde City,Ningde 352100,Fujian,China

關(guān)鍵詞:

橈骨骨折 Colles骨折 小夾板固定 骨牽引復(fù)位法

Keywords:

Radius fractures;  Colles' fracture;  Small splint fixation;  Skeletal tracting reposition

摘要:

目的:觀(guān)察手法復(fù)位超掌指關(guān)節(jié)夾板超腕關(guān)節(jié)夾板序貫固定治療橈骨遠(yuǎn)端骨折的臨床療效。方法:將符合要求的100例新鮮閉合性橈骨遠(yuǎn)端骨折患者隨機(jī)分為2組,每組50例。治療組經(jīng)手法復(fù)位后先采用超掌指關(guān)節(jié)夾板固定,2周后改為超腕關(guān)節(jié)夾板固定,對(duì)照組采用手法復(fù)位超腕關(guān)節(jié)夾板固定。2組患者均固定8周,并同時(shí)進(jìn)行藥物治療及功能鍛煉。比較2組患者復(fù)位8周后橈骨莖突高度、掌傾角和尺偏角的丟失值(復(fù)位8周后與復(fù)位后的差值),并于復(fù)位8周后采用Dienst標(biāo)準(zhǔn)評(píng)定患者的腕關(guān)節(jié)功能。結(jié)果:治療組復(fù)位8周后橈骨莖突高度丟失值和掌傾角丟失值均小于對(duì)照組[(4.60±1.33)mm,(6.52±1.39)mm,t=-4.121,P=0.000;(4.19°±1.28°),(5.98°±1.96°),t=-4.037,P=0.000]; 2組患者尺偏角丟失值比較,差異無(wú)統(tǒng)計(jì)學(xué)意義[(6.11°±1.47°),(6.28°±1.53°),t=-1.531,P=0.129]。復(fù)位8周后按照Dienst標(biāo)準(zhǔn)評(píng)定腕關(guān)節(jié)功能,治療組優(yōu)24例、良18例、可4例、差4例; 對(duì)照組優(yōu)15例、良15例、可14例、差6例。治療組腕關(guān)節(jié)功能優(yōu)于對(duì)照組(R^—_治療組=43.92,R^—_{對(duì)照組}=57.08; u=3.478,P=0.006)。結(jié)論:手法復(fù)位超掌指關(guān)節(jié)夾板超腕關(guān)節(jié)夾板序貫固定治療橈骨遠(yuǎn)端骨折,可有效避免骨折再移位,療效優(yōu)于手法復(fù)位超腕關(guān)節(jié)夾板固定治療。

Abstract:

Objective:To observe the clinical curative effect of manipulative reduction combined with external fixation using splint over metacarpophalangeal joint and splint over wrist joint in turn for the treatment of distal radius fractures.Methods:One hundred patients with fresh closed distal radius fractures who met the requirements were randomly divided into 2 groups,50 cases in each group.Patients in the treatment group were administrated with manipulative reduction combined with external fixation using splint over metacarpophalangeal joint followed by external fixation using splint over wrist joint 2 weeks later,while the others in the control group were administrated with manipulative reduction combined with external fixation using splint over wrist joint.All patients in the 2 groups were maintained in external fixation for consecutive 8 weeks,meanwhile,drug treatment and functional exercises were undertake.Eight weeks after reduction,the 2 groups were compared with each other in the loss(differences between post-reduction and 8 weeks post-reduction)of radial height,volar tilt angle and radial inclination angle,and the wrist function were evaluated.Results:Eight weeks after reduction,the loss of radial height and volar tilt angle of treatment group were all lower than those of control group((4.60±1.33)mm vs(6.52±1.39)mm,t=-4.121,P=0.000;(4.19°±1.28°)vs(5.98°±1.96°),t=-4.037,P=0.000),while there was no statistical difference in the loss of radial inclinations angle between the 2 groups((6.11°±1.47°)vs(6.28°±1.53°),t=-1.531,P=0.129).Eight weeks after reduction,according to Dienst wrist function assessment standard,24 patients obtained an excellent result,18 good,4 fair and 4 poor in the treatment group; while 15 patients obtained an excellent result,15 good,14 fair and 6 poor in the control group.The treatment group surpassed the control group in the wrist function(R^—_{treatment group}=43.92,R^—_{control group}=57.08; u=3.478,P=0.006).Conclusion:The fracture re-displacement can be effectively avoid in the treatment of distal radius fractures by manipulative reduction combined with external fixation using splint over metacarpophalangeal joint and splint over wrist joint in turn,which curative effect is better than that of manipulative reduction combined with external fixation using splint over wrist joint.

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