[1]刘欣,刘文刚,吴淮,等.3种方法治疗C型桡骨远端骨折的对比研究[J].中医正骨,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.
点击复制

3种方法治疗C型桡骨远端骨折的对比研究()
分享到：

《中医正骨》[ISSN:1001-6015/CN:41-1162/R]

卷:
第27卷
期数:
2015年05期
页码:
12-16
栏目:
临床研究
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:
刘欣; 刘文刚; 吴淮; 赵传喜
广东省第二中医院,广东 广州 510095
Author(s):
LIU Xin; LIU Wengang; WU Huai; ZHAO Chuanxi
Guangdong Second Traditional Chinese Medicine Hospital,Guangzhou 510095, Guangdong,China
关键词:
桡骨骨折;  正骨手法;  骨折固定术; 内;  骨板;  回顾性研究
Keywords:
radius fractures;  bone setting manipulation;  fracture fixation; internal;  bone plates;  retrospective studies
摘要:
目的:比较手法复位小夹板固定、掌侧入路切开复位内固定及背侧入路切开复位内固定治疗C型桡骨远端骨折的临床疗效和安全性。方法:回顾性分析91例单侧新鲜闭合性C型桡骨远端骨折患者的病例资料,33例采用手法复位小夹板外固定治疗(非手术组),31例采用掌侧入路切开复位内固定治疗(掌侧入路组),27例采用背侧入路切开复位内固定治疗(背侧入路组)。比较3组骨折复位情况、骨折愈合时间、腕关节功能及并发症发生情况。结果:3组桡骨高度比较,差异有统计学意义[(10.6±0.4)mm,(11.8±0.3)mm,(11.7±0.4)mm,F=97.704,P=0.000]; 非手术组桡骨高度小于掌侧入路组和背侧入路组(P=0.000,P=0.000); 掌侧入路组和背侧入路组桡骨高度比较,差异无统计学意义(P=0.331)。3组尺偏角、掌倾角及骨折愈合时间比较,组间差异均无统计学意义[(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组患者治疗后6个月Gartland-Werley评分比较,差异有统计学意义[(9.80±7.89)分,(8.70±7.41)分,(13.60±7.56)分,F=3.660,P=0.044]; 非手术组和掌侧入路组的Gartland-Werley评分均低于背侧入路组(P=0.046,P=0.011); 非手术组和掌侧入路组比较,差异无统计学意义(P=0.568)。治疗后非手术组3例出现肌腱刺激征、2例出现正中神经损伤症状,掌侧入路组3例出现肌腱刺激征、3例出现正中神经损伤症状、3例出现桡神经损伤症状,背侧入路组9例出现肌腱刺激征、1例出现正中神经损伤症状。3组正中神经损伤症状发生率比较,差异无统计学意义(P=0.768)。3组肌腱刺激征发生率比较,差异有统计学意义(χ2=7.922,P=0.020); 背侧入路组的发生率高于非手术组和掌侧入路组(χ2=5.455,P=0.010; χ2=4.921,P=0.007; α'=0.017); 掌侧入路组和非手术组比较,差异无统计学意义(P=1.000)。结论:手法复位小夹板固定和经掌侧入路切开复位内固定治疗C型桡骨远端骨折的临床疗效和安全性均优于经背侧入路切开复位内固定术,在临床中可根据骨折情况和患者需求灵活选择。
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.

参考文献/References:

[1] 李利军,魏杰,宋洁富,等.Sauve-Kapandji手术治疗陈旧性伴桡骨短缩的桡骨远端骨折的疗效观察[J].中国医师进修杂志,2011,34(11):40-41.
[2] 张恒富,蒋明华.老年C3型桡骨远端骨折两种手术治疗方法疗效观察[J].海南医学,2012,23(10):15-17.
[3] 谭诗平,张敬贤.掌侧锁定钢板固定老年不稳定性桡骨远端骨折[J].实用老年医学,2011,25(6):499-501.
[4] Bini A,Surace MF,Pilato G.Complex articular fractures of the distal radius: the role of closed reduction and external fixation[J].J Hand Surg Eur Vol,2008,33(3):305-310.
[5] 国家中医药管理局.中医病证诊断疗效标准[S].南京:南京大学出版社,1994:168.
[6] Sarmiento A,Pratt GW,Berry NC,et al.Colles' fractures.Functional bracing in supination[J].J Bone Joint Surg Am,1975,57(3):311-317.
[7] Rein S,Schikore H,Schneiders W,et al.Results of dorsal or volar plate fixation of AO type C3 distal radius fractures:a retrospective study[J].J Hand Surg Am,2007,32(7):954-961.
[8] Huang J.Comparison between volar and dorsal plate positions in the treatment of unstable fracture of distal radius[J].Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi,2008,22(8):948-951.
[9] Rozental TD,Blazar PE.Functional outcome and complications after volar plating for dorsally displaced,unstable fractures of the distal radius[J].J Hand Surg Am,2006,31(3):359-365.
[10] 费俊梁,王黎明,蒋纯志.桡骨远端骨折对腕关节稳定性的影响[J].中华外科杂志,2008,46(1):34-37.
[11] 苑文杰.锁定钢板治疗桡骨远端骨折36例疗效观察[J].临床和实验医学杂志,2012,11(15):1232-1233.
[12] Demirba �瘙 塂 ER,U(ˇoverg)ra �瘙 塂 AA,Kaya I.Volar plate fixation of distal radius fractures[J].Ulus Travma Acil Cerrahi Derg,2012,18(2):162-166.
[13] 金建强,张骏,陆逸庭,等.解剖型桡骨远端掌侧锁定接骨板治疗老年桡骨远端骨折[J].中医正骨,2013,25(12):66-68.
[14] 胡庆丰,范顺武,周辉,等.掌侧T形锁定加压接骨板治疗老年桡骨远端骨折[J].中国骨伤,2007,20(4):268-270.
[15] 边朝辉,沈文,李国胜,等.小夹板固定与锁定钛板内固定治疗桡骨远端骨折的疗效比较[J].中国临床医生,2011,39(8):59-61.
[16] 刘毅,陈海云,朱书敏,等.骨质疏松性桡骨远端骨折两种治疗方法的疗效比较[J].中国骨科临床与基础研究杂志,2012,4(1):18-22.
[17] 宫福良,李杰,范钦波,等.三种不同方法治疗桡骨远端不稳定骨折的功能对比研究[J].中国骨与关节损伤杂志,2011,26(9):842-843.
[18] Ring D,Jupiter JB,Brennwald J,et al.Prospective multicenter trial of a plate for dorsal fixation of distal radius fractures[J].J Hand Surg Am,1997,22(5):777-784.
[19] Rozental TD,Beredjiklian PK,Bozentka DJ.Functional outcome and complications following two types of dorsal plating for unstable fractures of the distal part of the radius[J].J Bone Joint Surg Am,2003,85-A(10):1956-1960.
[20] Jaremko JL,Lambert R,Rowe BH,et al.Do radiographic indices of distal radius fracture reduction predict outcomes in older adults receiving conservative treatment?[J].Clin Radiol,2007,62(1):65-72.
[21] 薛理新,季宝兵,戴桂龙.导致桡骨远端骨折术后桡骨短缩的发生率及其危险因素分析[J].中国骨与关节损伤杂志,2014,29(1):52-54.
[22] 张铁刚,苏群峰,左凤祥,等.牵旋背顶提按法整复结合超腕夹板固定治疗老年桡骨远端伸直型粉碎性骨折[J].中医正骨,2013,25(3):59-61.
[23] 夏羿凡,吴青,蔚芃.老年人桡骨远端骨折的手术与非手术疗效对比[J].按摩与康复医学,2012,3(7):9-11.
[24] Arora R,Gabl M,Gschwentner M,et al.A comparative study of clinical and radiologic outcomes of unstable colles type distal radius fractures in patients older than 70 years:nonoperative treatment versus volar locking plating[J].J Orthop Trauma,2009,23(4):237-242.

相似文献/References:

[1]朱峰,宋相建,吴蔚,等.手法复位经皮克氏针内固定治疗 儿童闭合性肱骨远端全骨骺分离[J].中医正骨,2015,27(11):51.
[2]沈海,刘昕,彭玉兰,等.复位架牵引下手法复位经皮穿针内固定治疗 儿童肱骨髁上骨折的临床研究[J].中医正骨,2015,27(10):1.
　SHEN Hai,LIU Xin,PENG Yulan,et al.Clinical study on reduction frame traction combined with manipulative reduction and percutaneous Kirschner wire internal fixation for treatment of humeral supracondylar fractures in children[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2015,27(05):1.
[3]王 强.胫腓下联合骨牵引配合手法整复小夹板外固定治疗 儿童闭合移位性股骨干骨折[J].中医正骨,2015,27(10):15.
[4]徐善强,陈星,张兴平,等.功能锻炼对桡骨远端骨折拆除石膏外固定后 腕关节康复的影响[J].中医正骨,2015,27(10):58.
[5]伍辉国,江克罗,张文正,等.手法复位杉树皮小夹板固定治疗儿童闭合性指骨骨折[J].中医正骨,2015,27(10):63.
[6]袁荣霞,董霞,赵纯,等.改良折顶手法复位小夹板固定治疗儿童尺桡骨远端双骨折[J].中医正骨,2015,27(08):18.
[7]刘震,胡志国,付伟.抖牵旋按复位结合钢针撬拨复位空心钉内固定治疗 难复性股骨颈骨折[J].中医正骨,2015,27(08):28.
[8]郭振平,李占国,刘一,等.陈氏正骨手法治疗肩关节脱位的优势及特色[J].中医正骨,2015,27(08):67.
[9]赵萌,陈云丰,周祖忠.切开复位T形钢板联合空心钉内固定治疗 MasonⅢ型桡骨头骨折[J].中医正骨,2015,27(07):58.
[10]江克罗,伍辉国,张文正,等.手法复位经皮穿针内固定治疗 开放性掌骨骨折合并腕掌关节脱位[J].中医正骨,2015,27(07):63.
[11]张容超,徐卫国,万春友,等.手法整复小夹板固定治疗桡骨远端骨折168例[J].中医正骨,2015,27(11):61.
[12]郭世明,石玲玲,郭志民,等.手法复位石膏外固定和切开复位钢板内固定治疗 骨质疏松性桡骨远端骨折的比较研究[J].中医正骨,2015,27(04):15.
　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(05):15.
[13]郑移兵,鲍树仁,齐越峰,等.推压手法复位纸夹板外固定治疗Smith骨折[J].中医正骨,2016,28(03):45.
[14]王国林,高彦平,樊培新.手法复位经皮克氏针内固定硫酸钙填充治疗桡骨远端粉碎性骨折[J].中医正骨,2016,28(03):48.
[15]聂伟志,隋显玉.牵屈复位半管形石膏固定治疗老年Colles骨折[J].中医正骨,2016,28(03):50.
[16]桂光明,曹波,张惠,等.石膏托和小夹板外固定对Colles骨折复位后短期位置丢失的影响[J].中医正骨,2016,28(04):19.
　GUI Guangming,CAO Bo,ZHANG Hui,et al.Effect of plaster slab external fixation and small splint external fixation on short-term position loss after reduction of Colles fractures[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2016,28(05):19.
[17]谢正虎,董霞,袁荣霞,等.手法复位夹板外固定与切开复位钢板内固定治疗老年桡骨远端C型骨折的比较研究[J].中医正骨,2016,28(10):18.
　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(05):18.
[18]霍乐乐,周中华,樊立波,等.闭合复位经皮穿针固定联合微创植骨治疗桡骨远端骨折[J].中医正骨,2017,29(02):65.
[19]从庆武,刘磊,王冲,等.持续牵引下闭合复位克氏针内固定治疗桡骨远端骨折[J].中医正骨,2017,29(11):74.
[20]周志,刘建,张挺,等.超声引导下闭合复位微创掌侧锁定钢板内固定治疗桡骨远端骨折[J].中医正骨,2019,31(07):48.

备注/Memo

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