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[1]謝正虎,董霞,袁榮霞,等.手法復(fù)位夾板外固定與切開復(fù)位鋼板內(nèi)固定治療老年橈骨遠端C型骨折的比較研究[J].中醫(yī)正骨,2016,28(10):18-23.
　XIE Zhenghu,DONG Xia,YUAN Rongxia,et al.A comparative study of manipulative reduction and splint external fixation versus open reduction and plate internal fixation for treatment of type-C fractures of distal radius in the aged[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2016,28(10):18-23.
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手法復(fù)位夾板外固定與切開復(fù)位鋼板內(nèi)固定治療老年橈骨遠端 C型骨折的比較研究()
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《中醫(yī)正骨》[ISSN:1001-6015/CN:41-1162/R]

卷:
第28卷
期數(shù):
2016年10期
頁碼:
18-23
欄目:
臨床研究
出版日期:
2016-10-20

文章信息/Info

Title:
A comparative study of manipulative reduction and splint external fixation versus open reduction and plate internal fixation for treatment of type-C fractures of distal radius in the aged
作者:
謝正虎; 董霞; 袁榮霞; 劉枝城
四川省骨科醫(yī)院,四川 成都 610041
Author(s):
XIE Zhenghu; DONG Xia; YUAN Rongxia; LIU Zhicheng
Sichuan Orthopaedic Hospital,Chengdu 610041,Sichuan,China
關(guān)鍵詞:
橈骨骨折;  小夾板固定;  正骨手法;  骨折固定術(shù); 內(nèi);  老年人;  臨床試驗
Keywords:
radius fractures;  small splint fixation;  bone setting manipulation;  fracture fixation; internal;  aged;  clinical trial
摘要:
目的:比較手法復(fù)位夾板外固定與切開復(fù)位鋼板內(nèi)固定治療老年橈骨遠端C型骨折的臨床療效和安全性。方法:回顧性分析73例老年橈骨遠端C型骨折患者的病例資料,其中采用手法復(fù)位夾板外固定37例,采用切開復(fù)位鋼板內(nèi)固定36例。男46例,女27例; 年齡61～80歲,中位數(shù)67歲; 按照橈骨遠端骨折的AO分類,C1型41例、C2型21例、C3型11例。比較治療結(jié)束后12個月時2組患者的腕關(guān)節(jié)活動度(背伸、掌曲、尺偏、橈偏、旋前、旋后)、掌傾角、尺偏角、Gartland-Werley腕關(guān)節(jié)功能評分、疼痛視覺模擬評分(visual analogue score,VAS)、臨床綜合療效及并發(fā)癥發(fā)生情況。結(jié)果:治療結(jié)束后12個月,2組患者腕關(guān)節(jié)背伸(59°±10°,61°±7°,t=0.386,P=0.142)、掌屈(55°±11°,57°±10°,t=0.069,P=0.510)、尺偏(33°±5°,35°±8°,t=0.058,P=0.883)、橈偏(24°±6°,25°±7°,t=0.121,P=0.521)、旋前(84°±7°,85°±8°,t=0.692,P=0.534)、旋后(83°±6°,85°±8°,t=0.635,P=0.992)角度及Gartland-Werley腕關(guān)節(jié)功能評分[(2.94±1.60)分,(2.28±0.79)分,t=1.854,P=0.061]、疼痛VAS評分[(1.38±0.70)分,(1.24±0.78)分,t=0.485,P=0.624]比較,組間差異均無統(tǒng)計學(xué)意義; 手法復(fù)位夾板外固定組掌傾角、尺偏角均小于切開復(fù)位鋼板內(nèi)固定組(3.00°±7.20°,10.40°±1.90°,t=0.000,P=0.041; 15.90°±9.00°,21.20°±2.60°,t=0.000,P=0.011)。按照Gartland-Werley腕關(guān)節(jié)功能評分標準評價臨床綜合療效,手法復(fù)位夾板外固定組優(yōu)14例、良17例、可6例,切開復(fù)位鋼板內(nèi)固定組優(yōu)16例、良16例、可4例; 2組患者臨床療效比較,差異無統(tǒng)計學(xué)意義(Z=-0.700,P=0.484)。切開復(fù)位鋼板內(nèi)固定組3例出現(xiàn)腕管綜合征,2例發(fā)生感染,2例出現(xiàn)骨折延遲愈合; 手法復(fù)位夾板外固定組1例出現(xiàn)腕管綜合征,1例出現(xiàn)嚴重手指僵硬。2組并發(fā)癥發(fā)生率比較,差異無統(tǒng)計學(xué)意義(χ2=2.155,P=0.142)。結(jié)論:對于老年橈骨遠端C型骨折患者而言,雖然手法復(fù)位夾板外固定和切開復(fù)位鋼板內(nèi)固定在改善腕關(guān)節(jié)活動度、緩解疼痛、恢復(fù)腕關(guān)節(jié)功能、安全性及臨床綜合療效等方面無明顯差異,但切開復(fù)位鋼板內(nèi)固定在骨折解剖復(fù)位方面優(yōu)于手法復(fù)位夾板外固定,臨床上可根據(jù)患者具體情況選擇相應(yīng)的治療方式。
Abstract:
Objective:To compare the clinical curative effect and safety of manipulative reduction and splint external fixation versus open reduction and plate internal fixation in the treatment of type-C fractures of distal radius in the aged.Methods:The medical records of 73 aged patients with type-C fractures of distal radius were analyzed retrospectively.Thirty-seven patients were treated with manipulative reduction and splint external fixation(group A),while the others were treated with open reduction and plate internal fixation(group B).The patients consisted of 46 males and 27 females,and ranged in age from 61 to 80 years(Median=67 yrs).According to the AO classification of distal radius fracture,the fractures belonged to types C1(41),C2(21)and C3(11).The range of motion(including dorsiflexion,palmar flexion,ulnar deviation,radial deviation,pronation,supination)of wrist,volar tilt angles,radial inclination angles,Gartland-Werley wrist function scores,wrist pain visual analogue score(VAS),clinical comprehensive curative effect and complications were recorded and compared between the 2 groups at 12 months after the end of the treatment.Results:There was no statistical difference in the angles of dorsiflexion(59+/-10 vs 61+/-7 degrees,t=0.386,P=0.142),palmar flexion(55+/-11 vs 57+/-10 degrees,t=0.069,P=0.510),ulnar deviation(33+/-5 vs 35+/-8 degrees,t=0.058,P=0.883),radial deviation(24+/-6 vs 25+/-7 degrees,t=0.121,P=0.521),pronation(84+/-7 vs 85+/-8 degrees,t=0.692,P=0.534),supination(83+/-6 vs 85+/-8 degrees,t=0.635,P=0.992)of wrist joints,Gartland-Werley wrist function scores(2.94+/-1.60 vs 2.28+/-0.79 points,t=1.854,P=0.061)and wrist pain VAS scores(1.38+/-0.70 vs 1.24+/-0.78 points,t=0.485,P=0.624)between the 2 groups at 12 months after the end of the treatment.The volar tilt angles and radial inclination angles were less in group A compared to group B(3.00+/-7.20 vs 10.40+/-1.90 degrees,t=0.000,P=0.041; 15.90+/-9.00 vs 21.20+/-2.60 degrees,t=0.000,P=0.011).The clinical comprehensive curative effects were evaluated according to Gartland-Werley wrist function scoring standard.Fourteen patients obtained an excellent result,17 good and 6 fair in group A,while 16 patients obtained an excellent result,16 good and 4 fair in group B.There was no statistical difference in clinical comprehensive curative effects between the 2 groups(Z=-0.700,P=0.484).The carpal tunnel syndrome(3),infection(2)and delayed union of fracture(2)were found in group B,while carpal tunnel syndrome(1)and severe finger anchylosis(1)were found in group A.There was no statistical difference in complication incidences between the two groups(χ2=2.155,P=0.142).Conclusion:For aged patients with type-C fractures of distal radius,there is no significant difference in improvement in range of motion of wrist,relief of wrist pain,recovery of wrist function,safety and clinical comprehensive curative effect between open reduction plate internal fixation and manipulative reduction splint external fixation.However,the former surpasses the latter in anatomical reduction of the fractures,so suitable clinical treatment should be chosen in clinic according to patients' particular conditions.

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更新日期/Last Update: 2016-10-20