保守治疗60岁以上桡骨远端骨折的可行性研究  

Feasibility of conservative treatment of distal radius fracture in elderly patients

作　　者：李绍良[1] 高志强[1] 鲁谊[1] 安贵生[1] 王满宜[1] 

机构地区：[1]北京积水潭医院创伤骨科,100035

出　　处：《中华创伤骨科杂志》2012年第9期763-766,共4页Chinese Journal of Orthopaedic Trauma

摘　　要：目的通过与60岁以下桡骨远端骨折患者保守治疗后的影像学结果进行比较，分析60岁以上桡骨远端骨折患者保守治疗后的影像学结果，以确定老年患者是否适合采用保守治疗，方法对2010年7月至2011年3月收治的103例（104侧）桡骨远端骨折患者进行回顾性研究，男15例，女88例；年龄22～93岁，平均60．0岁。根据年龄将患者分为〈60岁组（48例）和／〉60岁组（55例）。所有患者均经闭合整复石膏固定后于1、2和4周复查x线片。根据Kreder方法测量x线片的掌倾角、尺偏角及桡骨短缩值。骨折愈合的影像学结果应用Lidstrom分级进行评价。统计并比较两组患者的保守}fi,疗结果：结果按照Lidstrom分级，104侧桡骨远端骨折经保守治疗后86．5％（90／104）的影像学结果可接受。〈60岁组和≥60岁组经保守治疗后可接受率分别为91．7％（44／48）和82．1％（46／56），两组比较差异无统计学意义（P=0．156）。结合年龄及骨折的稳定型分组后分析，〈60岁组和360岁组稳定骨折经保守治疗后可接受率分别为92．0％（23／25）和92．6％（25／27），而〈60岁组和≥60岁组不稳定骨折经保守治疗后可接受率分别为91．3％（21／23）和72．4％（21／29），两组比较差异均无统计学意义（P〉0．05）。结论多数老年患者的桡骨远端骨折经保守治疗后的影像学结果满意，与年轻患者差异不大。Objective To explore whether conservative treatment can be used for the elderly patients by comparing the radiographic functional outcomes following conservative treatment of dist＇,d radius fracture in the elderly patients （ ≥60 years） with those in the young patients （ 〈 60 years）. Methods From July 2010 to March 2011, 103 patients with 104 distal radius fractures were treated by closed reduction and plaster immobilization. They were 15 men and 88 women, aged from 22 to 93 years （average, 60.0 years） . There were 48 cases in the young group and 55 in the elderly group. They were weekly followed radiographically at 1. 2 aud 4 weeks post-treatment. The radial shortening, radial inclination and pahner tilt in the X-rays were measured by the Kreder method. The radiographic functional outcomes were evaluated by Lindstrom scoring system and dncumeuted and compared between the 2 groups. Results By Lindstrom scoring system, 86.5% （90/104） of the fractures achieved acceptable radiographic outcomes after conservative treatment. The rates of acceptable outcomes were respectively 91.7% （44/48） and 82. 1% （46/56） in the young and elderly groups, with no significant difference between the 2 groups （ P = 0. 156） . The rates of acceptable outcomes tor the stable fractures were respectively 92.0% （23/25） and 92.6% （25/27） in the young and eklerly groups： the rates of acceptable outcomes for the unstable fractures were respectively 91.3% （21/23） and 72.4% （21/29） in the young and elderly groups. There were no significant different differences between the 2 groups regarding the above comparisons （ P 〉 0. 05） . Conclusion Following conservative treatment, most elderly patients with distal radius fracture can achieve satisfactory radiographic outcomes which are not significantly different from those for young patients.

关 键 词：桡骨骨折 骨折固定术 石膏 外科 放射摄影术 

分 类 号：R687.3[医药卫生—骨科学]