[1]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):18-23.
　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()
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《中医正骨》[ISSN:1001-6015/CN:41-1162/R]

卷:
第28卷
期数:
2016年10期
页码:
18-23
栏目:
临床研究
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:
谢正虎; 董霞; 袁荣霞; 刘枝城
四川省骨科医院,四川 成都 610041
Author(s):
XIE Zhenghu; DONG Xia; YUAN Rongxia; LIU Zhicheng
Sichuan Orthopaedic Hospital,Chengdu 610041,Sichuan,China
关键词:
桡骨骨折;  小夹板固定;  正骨手法;  骨折固定术; 内;  老年人;  临床试验
Keywords:
radius fractures;  small splint fixation;  bone setting manipulation;  fracture fixation; internal;  aged;  clinical trial
摘要:
目的:比较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型骨折的临床疗效和安全性。方法:回顾性分析73例老年桡骨远端C型骨折患者的病例资料,其中采用手法复位夹板外固定37例,采用切开复位钢板内固定36例。男46例,女27例; 年龄61～80岁,中位数67岁; 按照桡骨远端骨折的AO分类,C1型41例、C2型21例、C3型11例。比较治疗结束后12个月时2组患者的腕关节活动度(背伸、掌曲、尺偏、桡偏、旋前、旋后)、掌倾角、尺偏角、Gartland-Werley腕关节功能评分、疼痛视觉模拟评分(visual analogue score,VAS)、临床综合疗效及并发症发生情况。结果:治疗结束后12个月,2组患者腕关节背伸(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)、桡偏(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腕关节功能评分[(2.94±1.60)分,(2.28±0.79)分,t=1.854,P=0.061]、疼痛VAS评分[(1.38±0.70)分,(1.24±0.78)分,t=0.485,P=0.624]比较,组间差异均无统计学意义; 手法复位夹板外固定组掌倾角、尺偏角均小于切开复位钢板内固定组(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腕关节功能评分标准评价临床综合疗效,手法复位夹板外固定组优14例、良17例、可6例,切开复位钢板内固定组优16例、良16例、可4例; 2组患者临床疗效比较,差异无统计学意义(Z=-0.700,P=0.484)。切开复位钢板内固定组3例出现腕管综合征,2例发生感染,2例出现骨折延迟愈合; 手法复位夹板外固定组1例出现腕管综合征,1例出现严重手指僵硬。2组并发症发生率比较,差异无统计学意义(χ2=2.155,P=0.142)。结论:对于老年桡骨远端C型骨折患者而言,虽然手法复位夹板外固定和切开复位钢板内固定在改善腕关节活动度、缓解疼痛、恢复腕关节功能、安全性及临床综合疗效等方面无明显差异,但切开复位钢板内固定在骨折解剖复位方面优于手法复位夹板外固定,临床上可根据患者具体情况选择相应的治疗方式。
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