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[1]劉欣,劉文剛,吳淮,等.3種方法治療C型橈骨遠(yuǎn)端骨折的對(duì)比研究[J].中醫(yī)正骨,2015,27(05):12-16.
　LIU Xin,LIU Wengang,WU Huai,et al.A comparative study of three methods for treatment of type C distal radius fractures[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2015,27(05):12-16.
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3種方法治療C型橈骨遠(yuǎn)端骨折的對(duì)比研究()
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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05期
頁(yè)碼:
12-16
欄目:
臨床研究
出版日期:
2015-05-30

文章信息/Info

Title:
A comparative study of three methods for treatment of type C distal radius fractures
作者:
劉欣; 劉文剛; 吳淮; 趙傳喜
廣東省第二中醫(yī)院,廣東 廣州 510095
Author(s):
LIU Xin; LIU Wengang; WU Huai; ZHAO Chuanxi
Guangdong Second Traditional Chinese Medicine Hospital,Guangzhou 510095, Guangdong,China
關(guān)鍵詞:
橈骨骨折;  正骨手法;  骨折固定術(shù); 內(nèi);  骨板;  回顧性研究
Keywords:
radius fractures;  bone setting manipulation;  fracture fixation; internal;  bone plates;  retrospective studies
摘要:
目的:比較手法復(fù)位小夾板固定、掌側(cè)入路切開復(fù)位內(nèi)固定及背側(cè)入路切開復(fù)位內(nèi)固定治療C型橈骨遠(yuǎn)端骨折的臨床療效和安全性。方法:回顧性分析91例單側(cè)新鮮閉合性C型橈骨遠(yuǎn)端骨折患者的病例資料,33例采用手法復(fù)位小夾板外固定治療(非手術(shù)組),31例采用掌側(cè)入路切開復(fù)位內(nèi)固定治療(掌側(cè)入路組),27例采用背側(cè)入路切開復(fù)位內(nèi)固定治療(背側(cè)入路組)。比較3組骨折復(fù)位情況、骨折愈合時(shí)間、腕關(guān)節(jié)功能及并發(fā)癥發(fā)生情況。結(jié)果:3組橈骨高度比較,差異有統(tǒng)計(jì)學(xué)意義[(10.6±0.4)mm,(11.8±0.3)mm,(11.7±0.4)mm,F=97.704,P=0.000]; 非手術(shù)組橈骨高度小于掌側(cè)入路組和背側(cè)入路組(P=0.000,P=0.000); 掌側(cè)入路組和背側(cè)入路組橈骨高度比較,差異無(wú)統(tǒng)計(jì)學(xué)意義(P=0.331)。3組尺偏角、掌傾角及骨折愈合時(shí)間比較,組間差異均無(wú)統(tǒng)計(jì)學(xué)意義[(19.1°±5.2°),(18.8°±3.5°),(18.2°±4.5°),F=2.227,P=0.109;(6.2°±5.3°),(8.1°±4.6°),(8.7°±5.8°),F=1.881,P=0.153;(11.60±1.04)周,(11.27±0.98)周,(11.40±1.13)周,F=0.810,P=0.450]。3組患者治療后6個(gè)月Gartland-Werley評(píng)分比較,差異有統(tǒng)計(jì)學(xué)意義[(9.80±7.89)分,(8.70±7.41)分,(13.60±7.56)分,F=3.660,P=0.044]; 非手術(shù)組和掌側(cè)入路組的Gartland-Werley評(píng)分均低于背側(cè)入路組(P=0.046,P=0.011); 非手術(shù)組和掌側(cè)入路組比較,差異無(wú)統(tǒng)計(jì)學(xué)意義(P=0.568)。治療后非手術(shù)組3例出現(xiàn)肌腱刺激征、2例出現(xiàn)正中神經(jīng)損傷癥狀,掌側(cè)入路組3例出現(xiàn)肌腱刺激征、3例出現(xiàn)正中神經(jīng)損傷癥狀、3例出現(xiàn)橈神經(jīng)損傷癥狀,背側(cè)入路組9例出現(xiàn)肌腱刺激征、1例出現(xiàn)正中神經(jīng)損傷癥狀。3組正中神經(jīng)損傷癥狀發(fā)生率比較,差異無(wú)統(tǒng)計(jì)學(xué)意義(P=0.768)。3組肌腱刺激征發(fā)生率比較,差異有統(tǒng)計(jì)學(xué)意義(χ2=7.922,P=0.020); 背側(cè)入路組的發(fā)生率高于非手術(shù)組和掌側(cè)入路組(χ2=5.455,P=0.010; χ2=4.921,P=0.007; α'=0.017); 掌側(cè)入路組和非手術(shù)組比較,差異無(wú)統(tǒng)計(jì)學(xué)意義(P=1.000)。結(jié)論:手法復(fù)位小夾板固定和經(jīng)掌側(cè)入路切開復(fù)位內(nèi)固定治療C型橈骨遠(yuǎn)端骨折的臨床療效和安全性均優(yōu)于經(jīng)背側(cè)入路切開復(fù)位內(nèi)固定術(shù),在臨床中可根據(jù)骨折情況和患者需求靈活選擇。
Abstract:
Objective:To compare the curative effect and safety of manipulative reduction and small splint fixation versus volar and dorsal open reduction internal fixation in the treatment of type C distal radius fractures.Methods:The medical records of 91 patients with unilateral fresh closed type C distal radius fracture were analyzed retrospectively.Thirty-three cases were treated with manual reduction and small splint fixation(non-operative group),while 31 cases were treated with open reduction internal fixation through volar approach(volar approach group)and 27 cases were treated with open reduction internal fixation through dorsal approach(dorsal approach group).The three groups were compared with each other in fracture reduction,fracture healing time,wrist function and complication rates.Results:There was statistical difference in the radial height between the 3 groups(10.6+/-0.4,11.8+/-0.3,11.7+/-0.4 mm; F=97.704,P=0.000),and the radial height was lower in non-operative group compared to volar approach group and dorsal approach group(P=0.000,P=0.000).There was no statistical difference in the radial height between volar approach group and dorsal approach group(P=0.331).No statistical difference was found in the radial inclination angles,volar tilt angles and fracture healing time between the 3 groups(19.1+/-5.2,18.8+/-3.5,18.2+/-4.5 degrees,F=2.227,P=0.109; 6.2+/-5.3,8.1+/-4.6,8.7+/-5.8 degrees,F=1.881,P=0.153; 11.60+/-1.04,11.27+/-0.98,11.40+/-1.13 weeks,F=0.810,P=0.450).There was statistical difference in the Gartland-Werley score between the 3 groups at 6 months after the treatment(9.80+/-7.89,8.70+/-7.41,13.60+/-7.56 points,F=3.660,P=0.044).The Gartland-Werley scores were lower in non-operative group and volar approach group compared to dorsal approach group(P=0.046,P=0.011)and there was no statistical difference between non-operative group and volar approach group(P=0.568).After the treatment,3 cases with stimulant signs of tendon and 2 cases with symptoms of median nerve injury were found in non-operative group.Three cases with stimulant signs of tendon,3 cases with symptoms of median nerve injury and 3 cases with symptoms of radial nerve injury were found in volar approach group.Nine cases with stimulant signs of tendon and 1 cases with symptoms of median nerve injury were found in dorsal approach group.There was no statistical difference in incidence of median nerve injury between the 3 groups(P=0.768).There was statistical difference in incidence rate of tendon stimulant signs between the 3 groups(χ2=7.922,P=0.020),and the incidence rate was higher in dorsal approach group compared to non-operative group and volar approach group(χ2=5.455,P=0.010; χ2=4.921,P=0.007; α'=0.017)while no statistical difference was found between volar approach group and non-operative group(P=1.000).Conclusion:The curative effect and safety of manipulative reduction combined with small splint fixation and open reduction internal fixation through volar approach are better than those of open reduction internal fixation through dorsal approach in the treatment of type C distal radius fractures,and the two methods should be chosen according to the condition of fractures and patients' needs in clinic.

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2015-02-12收稿 2015-04-01修回
更新日期/Last Update: 2015-05-30