手法复位超掌指关节夹板超腕关节夹板序贯固定治疗桡骨远端骨折  

A randomized controlled trial of manipulative reduction combined with external fixation using splint over metacarpophalangeal joint and splint over wrist joint in turn for the treatment of distal radius fractures

作　　者：董森 陈祖平 李辉 

机构地区：[1]福建省宁德市中医院,福建宁德352100

出　　处：《中医正骨》2013年第7期16-19,共4页The Journal of Traditional Chinese Orthopedics and Traumatology

摘　　要：目的:观察手法复位超掌指关节夹板超腕关节夹板序贯固定治疗桡骨远端骨折的临床疗效。方法:将符合要求的100例新鲜闭合性桡骨远端骨折患者随机分为2组,每组50例。治疗组经手法复位后先采用超掌指关节夹板固定,2周后改为超腕关节夹板固定,对照组采用手法复位超腕关节夹板固定。2组患者均固定8周,并同时进行药物治疗及功能锻炼。比较2组患者复位8周后桡骨茎突高度、掌倾角和尺偏角的丢失值(复位8周后与复位后的差值),并于复位8周后采用Dienst标准评定患者的腕关节功能。结果:治疗组复位8周后桡骨茎突高度丢失值和掌倾角丢失值均小于对照组[(4.60±1.33)mm,(6.52±1.39)mm,t=-4.121,P=0.000;(4.19°±1.28°),(5.98°±1.96°),t=-4.037,P=0.000];2组患者尺偏角丢失值比较,差异无统计学意义[(6.11°±1.47°),(6.28°±1.53°),t=-1.531,P=0.129]。复位8周后按照Dienst标准评定腕关节功能,治疗组优24例、良18例、可4例、差4例;对照组优15例、良15例、可14例、差6例。治疗组腕关节功能优于对照组(R—治疗组=43.92,R—对照组=57.08;u=3.478,P=0.006)。结论:手法复位超掌指关节夹板超腕关节夹板序贯固定治疗桡骨远端骨折,可有效避免骨折再移位,疗效优于手法复位超腕关节夹板固定治疗。Objective：To observe the clinical curative effect of manipulative reduction combined with external fixation using splint over metacarpophalangeal joint and splint over wrist joint in turn for the treatment of distal radius fractures.Methods：One hundred patients with fresh closed distal radius fractures who met the requirements were randomly divided into 2 groups,50 cases in each group.Patients in the treatment group were administrated with manipulative reduction combined with external fixation using splint over metacarpophalangeal joint followed by external fixation using splint over wrist joint 2 weeks later,while the others in the control group were administrated with manipulative reduction combined with external fixation using splint over wrist joint.All patients in the 2 groups were maintained in external fixation for consecutive 8 weeks,meanwhile,drug treatment and functional exercises were undertake.Eight weeks after reduction,the 2 groups were compared with each other in the loss（differences between post-reduction and 8 weeks post-reduction）of radial height,volar tilt angle and radial inclination angle,and the wrist function were evaluated.Results：Eight weeks after reduction,the loss of radial height and volar tilt angle of treatment group were all lower than those of control group（（4.60±1.33）mm vs（6.52±1.39）mm,t=-4.121,P=0.000;（4.19°±1.28°）vs（5.98°±1.96°）,t=-4.037,P=0.000）,while there was no statistical difference in the loss of radial inclinations angle between the 2 groups（（6.11°±1.47°）vs（6.28°±1.53°）,t=-1.531,P=0.129）.Eight weeks after reduction,according to Dienst wrist function assessment standard,24 patients obtained an excellent result,18 good,4 fair and 4 poor in the treatment group;while 15 patients obtained an excellent result,15 good,14 fair and 6 poor in the control group.The treatment group surpassed the control group in the wrist function（R— treatment group=43.92,R— control group=57.08;u=3.478,P=0.006）.Conclusion：The fracture

关 键 词：桡骨骨折 COLLES骨折 小夹板固定 骨牵引复位法 

分 类 号：R687.3[医药卫生—骨科学]