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[1]郭世明,石玲玲,郭志民,等.手法復位石膏外固定和切開復位鋼板內固定治療 骨質疏松性橈骨遠端骨折的比較研究[J].中醫(yī)正骨,2015,27(04):15-20.
　GUO Shiming,SHI Lingling,GUO Zhimin,et al.A comparative study of manual reduction and plaster external fixation versus open reduction and plate internal fixation for treatment of osteoporotic distal radius fractures[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2015,27(04):15-20.
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手法復位石膏外固定和切開復位鋼板內固定治療 骨質疏松性橈骨遠端骨折的比較研究()
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《中醫(yī)正骨》[ISSN:1001-6015/CN:41-1162/R]

卷:
第27卷
期數(shù):
2015年04期
頁碼:
15-20
欄目:
臨床研究
出版日期:
2015-04-30

文章信息/Info

Title:
A comparative study of manual reduction and plaster external fixation versus open reduction and plate internal fixation for treatment of osteoporotic distal radius fractures
作者:
郭世明1; 石玲玲2; 郭志民2; 林燕萍3
1.福建中醫(yī)藥大學,福建 福州 350100;
2.中國人民解放軍第175醫(yī)院, 福建 漳州 363000;
3.福建中醫(yī)藥大學中西醫(yī)結合研究院,福建 福州 350100
Author(s):
GUO Shiming1; SHI Lingling2; GUO Zhimin2; LIN Yanping3
1.Fujian University of Traditional Chinese Medicine,Fuzhou 350100,Fujian,China
2.The 175th Hospital of PLA,Zhangzhou 363000,Fujian,China
3.Academy of Integrative Medicine affiliated to Fujian University of Traditional Chinese Medicine,Fuzhou 350100,Fujian,China
關鍵詞:
橈骨骨折;  骨質疏松性骨折;  正骨手法;  石膏; 外科;  骨折固定術; 內;  內固定器;  治療; 臨床研究性
Keywords:
radius fractures;  osteoporotic fractures;  bone setting manipulation;  casts; surgical;  fracture fixation; internal;  internal fixators;  therapies; investigational
摘要:
目的:比較手法復位石膏外固定和切開復位鋼板內固定治療骨質疏松性橈骨遠端骨折的臨床療效和安全性。方法:回顧性分析73例骨質疏松性橈骨遠端骨折患者的病例資料,其中采用手法復位石膏外固定44例,采用切開復位鋼板內固定29例。男32例,女41例; 年齡60～79例,中位數(shù)69歲; 左側27例,右側46例; 按照橈骨遠端骨折的AO分類,A3型18例、B2型8例、B3型12例、C1型19例、C2型16例。記錄并比較2組患者骨折愈合時間、掌傾角和尺偏角及并發(fā)癥發(fā)生情況。記錄并比較2組患者骨折愈合時及骨折愈合后6個月的前臂旋前角度、前臂旋后角度及Robbins腕關節(jié)評分。結果:手法復位石膏外固定組骨折愈合時間、掌傾角、尺偏角均小于切開復位鋼板內固定組[(9.75±1.04)周,(11.83±0.75)周,t=17.280,P=0.001; 9.88°±1.47°,12.43°±1.27°,t=10.509,P=0.007; 21.13°±0.85°,22.72°±0.66°,t=14.350,P=0.003]。骨折愈合時手法復位石膏外固定組前臂旋前、旋后角度及Robbins腕關節(jié)評分均低于切開復位鋼板內固定組[25.63°±6.72°,51.17°±8.93°,t=37.555,P=0.000; 22.13°±4.58°,51.33°±5.72°,t=113.150,P=0.000;(3.88±0.64)分,(6.00±0.59)分,t=67.632,P=0.000]; 骨折愈合后6個月2組患者前臂旋前、旋后角度及Robbins腕關節(jié)評分比較,組間差異均無統(tǒng)計學意義[77.50°±6.74°,81.50°±4.60°,t=1.554,P=0.236; 73.63°±5.71°,73.50°±1.87°,t=0.003,P=0.960;(7.63±0.92)分,(8.00±1.06)分,t=1.479,P=0.236]。2組患者并發(fā)癥發(fā)生率比較,差異無統(tǒng)計學意義(χ2=0.052,P=0.820)。結論:對于骨質疏松性橈骨遠端骨折患者而言,在骨折復位以及骨折愈合時的腕關節(jié)活動能力和功能方面,切開復位鋼板內固定優(yōu)于手法復位石膏外固定; 但手法復位石膏外固定的骨折愈合時間短,且骨折愈合后6個月的腕關節(jié)功能及安全性方面與切開復位鋼板內固定無明顯差異,符合老年患者的治療要求,可作為臨床治療骨質疏松性橈骨遠端骨折的一種較為理想的選擇。
Abstract:
Objective:To compare the clinical curative effect and safety of manual reduction and plaster external fixation versus open reduction and plate internal fixation in the treatment of osteoporotic distal radius fractures(ODRF).Methods:The medical records of 73 patients with ODRF were analyzed retrospectively.Forty-four patients were treated with manual reduction and plaster external fixation,while the others were treated with open reduction and plate internal fixation.The patients consisted of 32 males and 41 females,and ranged in age from 60 to 79 years(Median=69 yrs).The fractures located in left radius for 27 patients and right radius for 46 patients.According to the AO classification of distal radius fracture,the fractures belonged to types A3(18),B2(8),B3(12),C1(19)and C2(16).The fracture healing time,volar tilt angles,radial inclination angles and complications were recorded and compared between the 2 groups.The antebrachial pronation angles,antebrachial supination angles and Robbins wrist scores were also recorded and compared between the 2 groups when the fractures healed and at 6 months after the fracture healing.Results:Fracture healing time,volar tilt angles and radial inclination angles were less in manual reduction and plaster external fixation group compared to open reduction and plate internal fixation group(9.75+/-1.04 vs 11.83+/-0.75 weeks,t=17.280,P=0.001; 9.88+/-1.47 vs 12.43+/-1.27 degrees,t=10.509,P=0.007; 21.13+/-0.85 vs 22.72+/-0.66 degrees,t=14.350,P=0.003).Antebrachial pronation angles,antebrachial supination angles and Robbins wrist scores were less in manual reduction and plaster external fixation group compared to open reduction and plate internal fixation group when the fractures healed(25.63+/-6.72 vs 51.17+/-8.93 degrees,t=37.555,P=0.000; 22.13+/-4.58 vs 51.33+/-5.72 degrees,t=113.150,P=0.000; 3.88+/-0.64 vs 6.00+/-0.59 points,t=67.632,P=0.000).There was no statistical difference in antebrachial pronation angles,antebrachial supination angles and Robbins wrist scores between the 2 groups at 6 months after the fracture healing(77.50+/-6.74 vs 81.50+/-4.60 degrees,t=1.554,P=0.236; 73.63+/-5.71 vs 73.50+/-1.87 degrees,t=0.003,P=0.960; 7.63+/-0.92 vs 8.00+/-1.06 points,t=1.479,P=0.236).There was no statistical difference in complication incidences between the two groups(χ2=0.052,P=0.820).Conclusion:For patients with ODRF,open reduction and plate internal fixation surpasses manual reduction and plaster external fixation in fracture reduction,daily activity and function of wrist when the fracture healed.However,shorter fracture healing time can be obtained by using manual reduction and plaster external fixation,and there is no significant difference in wrist joint function and safety between the 2 therapies at 6 months after the fracture healing.Therefore,the therapy of manual reduction and plaster external fixation can meet the requirement for treatment of aged patients and can be used as an ideal therapy for treatment of ODRF in clinic.

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備注/Memo

備注/Memo:
2014-09-22收稿 2014-11-02修回
基金項目:國家自然科學基金項目(81173282)
更新日期/Last Update: 2015-04-30