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[1]許晶晶,成永忠,程灝,等.外固定架外固定彎針撬撥治療粉碎性Colles骨折的臨床研究[J].中醫(yī)正骨,2019,31(10):12-16.
　XU Jingjing,CHENG Yongzhong,CHENG Hao,et al.A clinical study of frame external fixation combined with curved needle leverage reduction for treatment of comminuted Colles fractures[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2019,31(10):12-16.
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外固定架外固定彎針撬撥治療粉碎性Colles骨折的臨床研究()
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《中醫(yī)正骨》[ISSN:1001-6015/CN:41-1162/R]

卷:
第31卷
期數(shù):
2019年10期
頁(yè)碼:
12-16
欄目:
外固定技術(shù)
出版日期:
2019-10-20

文章信息/Info

Title:
A clinical study of frame external fixation combined with curved needle leverage reduction for treatment of comminuted Colles fractures
作者:
許晶晶1; 成永忠1; 程灝1; 黃曉宇1; 賀達(dá)1; 陳洋1; 蔡靜怡1; 溫建民1; 聶偉志2
(1.中國(guó)中醫(yī)科學(xué)院望京醫(yī)院,北京 100102; 2.山東省文登整骨醫(yī)院,山東 威海 264400)
Author(s):
XU Jingjing1; CHENG Yongzhong1; CHENG Hao1; HUANG Xiaoyu1; HE Da1; CHEN Yang1; CAI Jingyi1; WEN Jianmin1; NIE Weizhi2
1.Wangjing Hospital of China Academy of Chinese Medical Sciences,Beijing 100102,China 2.The Wendeng Osteopath Hospital,Weihai 264400,Shandong,China
關(guān)鍵詞:
Colles骨折;  骨折; 粉碎性;  骨折固定術(shù);  外固定器;  臨床試驗(yàn)
Keywords:
Colles'fracture;  fractures; comminuted;  fracture fixation;  external fixators;  clinical trial
摘要:
目的:探討外固定架外固定彎針撬撥治療粉碎性Colles骨折的臨床療效。方法:對(duì)2016年6月至2018年6月,分別采用外固定架外固定彎針撬撥和切開(kāi)復(fù)位鋼板內(nèi)固定治療的38例粉碎性Colles骨折患者的病例資料進(jìn)行回顧性分析。采用外固定架外固定彎針撬撥治療18例(外固定彎針撬撥組),采用切開(kāi)復(fù)位鋼板內(nèi)固定治療20例(鋼板內(nèi)固定組)。觀察骨折愈合情況。在術(shù)前、術(shù)后1 d、術(shù)后12周的X線片上測(cè)量2組患者患腕橈骨遠(yuǎn)端掌傾角。對(duì)比兩組患者末次隨訪時(shí)采用Gartland-Werley腕關(guān)節(jié)評(píng)分標(biāo)準(zhǔn)評(píng)價(jià)的患腕功能。結(jié)果:2組患者均獲隨訪,隨訪時(shí)間3～14個(gè)月,中位數(shù)4個(gè)月。38例患者骨折均愈合,外固定彎針撬撥組骨折愈合時(shí)間5～8周,中位數(shù)6周; 鋼板內(nèi)固定組骨折愈合時(shí)間6～10周,中位數(shù)8周; 外固定彎針撬撥組骨折愈合時(shí)間短于鋼板內(nèi)固定組(Z=-2.819,P=0.005)。患腕橈骨遠(yuǎn)端掌傾角,時(shí)間因素和分組因素不存在交互效應(yīng)(F=0.181,P=0.755); 2組患者患腕橈骨遠(yuǎn)端掌傾角總體比較,組間差異有統(tǒng)計(jì)學(xué)意義,即存在分組效應(yīng)(F=7.853,P=0.008); 手術(shù)前后不同時(shí)間點(diǎn)患腕橈骨遠(yuǎn)端掌傾角的差異有統(tǒng)計(jì)學(xué)意義,即存在時(shí)間效應(yīng)(F=54.373,P=0.000); 術(shù)前2組患者患腕橈骨遠(yuǎn)端掌傾角的差異無(wú)統(tǒng)計(jì)學(xué)意義(-17.6°±35.0°,-20.7°±15.4°,Z=-1.169,P=0.242),術(shù)后1 d、術(shù)后12周時(shí)外固定彎針撬撥組患腕橈骨遠(yuǎn)端掌傾角均大于鋼板內(nèi)固定組(11.7°±6.2°,6.6°±7.1°,t=2.362,P=0.024; 13.7°±9.7°,9.5°±5.4°,Z=-2.924,P=0.003)。末次隨訪時(shí),外固定彎針撬撥組患腕Gartland-Werley評(píng)分(4.17±3.28)分,優(yōu)8例、良8例、可2例; 鋼板內(nèi)固定組患腕Gartland-Werley評(píng)分(3.60±3.60)分,優(yōu)11例、良6例、可3例; 2組患腕功能評(píng)價(jià)結(jié)果的差異無(wú)統(tǒng)計(jì)學(xué)意義(Z=-0.419,P=0.675)。結(jié)論:外固定架外固定彎針撬撥治療粉碎性Colles骨折,與切開(kāi)復(fù)位鋼板內(nèi)固定相比,骨折愈合時(shí)間短,更有利于橈骨遠(yuǎn)端掌傾角的恢復(fù),但在腕關(guān)節(jié)功能恢復(fù)方面兩者療效相當(dāng)。
Abstract:
Objective:To explore the clinical curative effects of frame external fixation combined with curved needle leverage reduction for treatment of comminuted Colles fractures.Methods:The medical records of 38 patients with comminuted Colles fractures were analyzed retrospectively.Eighteen patients were treated with frame external fixation combined with curved needle leverage reduction(group A),while the others were treated with open reduction combined with plate internal fixation(group B).The fracture healing was observed.The distal radius volar tilt angle of affected wrist was measured on X-ray film taken before the surgery,at 1 day and 12 weeks after the surgery.The affected wrist functions were evaluated according to Gartland-Werley wrist function scoring standard at the last follow-up and were compared between the 2 groups.Results:All patients in the 2 groups were followed up for 3-14 months with a median of 4 months.All fractures healed,and the fracture healing time ranged from 5 to 8 weeks(Median=6 weeks)in group A and ranged from 6 to 10 weeks(Median=8 weeks)in group B.The fracture healing time was shorter in group A compared to group B(Z=-2.819,P=0.005).There was no interaction between time factor and group factor in distal radius volar tilt angle of affected wrist(F=0.181,P=0.755).There was statistical difference in distal radius volar tilt angle of affected wrist between the 2 groups in general,in other words,there was group effect(F=7.853,P=0.008).There was statistical difference in distal radius volar tilt angle of affected wrist between different timepoints before and after the surgery,in other words,there was time effect(F=54.373,P=0.000).There was no statistical difference in distal radius volar tilt angle of affected wrist between the 2 groups before the surgery(-17.6+/-35.0 vs -20.7+/-15.4 degrees,Z=-1.169,P=0.242).The distal radius volar tilt angles of affected wrists were larger in group A compared to group B at 1 day and 12 weeks after the surgery(11.7+/-6.2 vs 6.6+/-7.1 degrees,t=2.362,P=0.024; 13.7+/-9.7 vs 9.5+/-5.4 degrees,Z=-2.924,P=0.003).At the last follow-up,the Gartland-Werley scores were 4.17+/-3.28 points in group A and 3.60+/-3.60 points in group B; and 8 patients obtained an excellent result,8 good and 2 fair in group A; and 11 patients obtained an excellent result,6 good and 3 fair in group B.There was no statistical difference in the result of function evaluation of affected wrist between the 2 groups(Z=-0.419,P=0.675).Conclusion:Frame external fixation and curved needle leverage reduction has the advantages of shorter fracture healing time and better recovery of distal radius volar tilt angle compared to open reduction and plate internal fixation in treatment of comminuted Colles fractures,while they are similar to each other in the clinical curative effect on wrist function recovery.

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備注/Memo

備注/Memo:
基金項(xiàng)目:首都臨床特色研究與應(yīng)用推廣項(xiàng)目(Z161100000516111) 通訊作者:成永忠 E-mail:[email protected](收稿日期:2019-07-13 本文編輯:楊雅)
更新日期/Last Update: 2019-10-15