老年桡骨远端骨折的手术和非手术治疗的疗效观察  

Distal radial fractures in the elderly:operative compared with non-operative treatment in functional status

作　　者：张家红[1] 何继业[1] 王栋梁[1] 

机构地区：[1]上海交通大学医学院附属新华医院骨科,200092

出　　处：《中华临床医师杂志（电子版）》2012年第2期41-44,共4页Chinese Journal of Clinicians(Electronic Edition)

摘　　要：目的对老年桡骨远端移位骨折进行手术和非手术治疗的疗效进行比较。方法共收集65岁以上手术或非手术治疗的桡骨远端骨折80例,患者初始都接受骨折闭合复位石膏固定,部分患者因复位不理想而接受手术治疗。结合患者术前腕部X线片和关节功能指数的测定,进行治疗后2周、6周、12周、24周、52周的临床和X线片随访,在规定时间点采用t检验比较两组病例的关节功能测定结果。结果 46例采用非手术治疗,34例采用手术治疗。24周时的手术组患者腕背伸功能好于非手术患者(P=0.04),而一年随访时这种差异性消失。运用美国臂肩手功能评分和疼痛评分对两组进行各时间点的功能随访,结果无明显差异。两组的并发症发生率也无明显差异。结论非手术治疗的桡骨远端骨折的老年患者,其远期的疼痛和功能指数与接受手术治疗的老年患者基本相同。Objective To compare outcomes for elderly patients with a displaced distal radial fracture who were treated with or without surgical intervention. Methods This case-control study examined eighty patients over the age of sixty-five who were treated with or without surgery for a displaced distal radial fracture. All fractures were initially treated with closed reduction and splinting. Patients who failed an acceptable closed reduction were offered surgical intervention. Base!ine radiographs and functional scores were obtained prior to treatment. Follow-up was conducted at two, six, twelve, twenty-four, and fifty-two weeks. Clinical and radio graphic follow-up was completed at each visit,while functional scores were obtained at the twelve,twenty-four,and fifty-two-week follow-up evaluations. Outcomes at fixed time points were compared between groups with the student t test. Results Forty-six patients with a mean age of seventy-six years were treated non-operatively, and thirty-four patients were treated operatively. At twenty-four weeks,patients who underwent surgery had .better wrist extension （P = 0. 04）than those who had no surgery. At one year,this difference was not seen. No difference in functional status based on the Disabilities of the Arm, Shoulder and Hand scores and pain scores at any of the follow-up points was seen between the groups. There was no difference between the groups with regard to complications. Conclusions The older patients who were treated non-operatively had functional scores of pain and results equivalent to those of elderly patients who had surgical treatment for a displaced distal radius.

关 键 词：桡骨骨折 老年人 治疗结果 

分 类 号：R687.3[医药卫生—骨科学]