手法复位小夹板外固定治疗C型老年桡骨远端骨折的前瞻性随机对照临床试验  

Manipulative reduction and small splint external fixation for the treatment of type C distal radial fractures in the elderly:a prospective,randomized,controlled clinical trial

作　　者：程国杰 吕发明 艾克巴尔 杨春 王筠 

机构地区：[1]新疆维吾尔自治区中医医院创伤骨科,新疆乌鲁木齐市830000

出　　处：《中国骨质疏松杂志》2012年第7期636-640,635,共6页Chinese Journal of Osteoporosis

基　　金：国家科技支撑计划(2007BAI07A00)资助

摘　　要：目的探讨手法复位小夹板固定治疗C型老年桡骨远端骨折的可行性及临床应用价值。方法采用单中心对照试验,观测时间为18月,其中小夹板、石膏管型外固定组干预1个月,随访17个月;外固定架组干预6～8周,LCP组(锁定加压钢板)和外固定架组随访18个月。对来自2007年1月至2010年3月新疆维吾尔自治区中医医院创伤骨科门诊及病房的328例AO分类属C型的老年桡骨远端骨折患者,根据是否愿意接受手术治疗分为保守组192例和手术组136例。再采用随机区组的方法随机分为小夹板外固定96例,石膏管型外固定96例;LCP组68例,外固定架组68例。运用改良Green与O’Brien评分进行疼痛、功能、活动度、握力的评价;影像学方面采用Stewart与改良的Sanniento评分方法对桡骨高度短缩、尺偏角、掌倾角进行对比。结果随访3个月时,四组之间腕关节功能评价具有统计学意义(P<0.05),其中小夹板组比石膏固定组功能优越(P<0.05);LCP组与外固定架组功能相当(P>0.05);LCP组与外固定架组比小夹板组与石膏组功能优越(P<0.05)。随访18个月时,四组之间腕关节功能差异无统计学意义(P>0.05)。3个月时影像学比较四组之间有统计学意义(P<0.05),其中小夹板与石膏固定在3个月时桡骨高度短缩、尺偏角减小、掌倾角减小方面无统计学意义(P>0.05),LCP与外固定架组间有统计学意义(P<0.05)。小夹板与LCP组、小夹板与外固定架组间有统计学意义(P<0.05),石膏与LCP组、石膏与外固定架组之间有统计学意义(P<0.05)。结论老年C型桡骨远端骨折短期内手术治疗比非手术治疗在腕关节功能恢复及影像学方面有优势,一年后功能状态相差不大。Objective To explore the teasibility and clinical apphcatlon value ot manipulative reciuctlon anO small splint fixation for the treatment of type C distal radial fractures in elderly patients. Methods Single center comparison test was used for 18 months of the observation time. The intervention time in small splint and tube plaster external fixator group lasted for 1 month, then the patients were followed up for 17 months. The intervention time in external fixator group lasted for 6-8 weeks. The patients in the locking compression plate （LCP） and external fixator group were followed up for 18 months. Three hundred and twenty-eight elderly patients with type-C distal radial fractures according to AO classification were chosen in this study from January 2007 to March 2010. They were divided into the operative group （136 cases） and the conservative group （ 192 cases）. The patients in conservative group were randomly divided into small splint external fixation group （96 cases） and gypsum pipe type external fixation group （96 cases）. The patients in the operation group were randomly divided into LCP group （68 cases） and external fixator group （68cases）. The pain, activity level, and grip strength were evaluated with modified Green and O＇Brnen demerit-point system. Radial height shortening, ulnar palmar, and tilt angle were evaluated with Stewart and modified Sanniento scoring method. Result After 3-month follow-up, the differences of wrist function evaluation among patients in the 4 groups were statistically significant （P 〈 0.05 ）. The function of patients in small splint fixation group function was superior to that in gypsum group （ P 〈 0.05 ）. The function of patients in LCP group was similar with that in the external fixator group （P 〉 0. 05 ）. The wrist function of patients in the LCP group and external fixator group was superior to that in the small splint group and gypsum group （P 〈 0.05）. After 18-month follow-up, the differences of wrist function evaluatio

关 键 词：手法复位 小夹板固定 切开复位内固定 老年桡骨远端骨折 石膏固定 外固定架固定 

分 类 号：R681[医药卫生—骨科学]