小夹板外固定对不同类型Colles骨折固定效果的对比研究  

Comparative study on the fixation effects of small splint external fixation in treatment of different types of Colles fractures

作　　者：郑军[1] 辛宗山[1] 操儒道[1] 毛丰[1] 马维初[1] 

机构地区：[1]湖北省钟祥市人民医院,湖北钟祥431900

出　　处：《中医正骨》2016年第4期25-28,32,共5页The Journal of Traditional Chinese Orthopedics and Traumatology

摘　　要：目的:比较小夹板外固定对3种类型Colles骨折的固定效果。方法:回顾性分析62例采用手法复位小夹板外固定治疗的Colles骨折患者的病例资料;按AO分型标准,A型9例(A型组)、B型28例(B型组)、C型25例(C型组)。所有患者均按照《中医骨伤科常见病诊疗指南》中桡骨远端骨折的操作规范进行手法复位小夹板外固定。根据X线片评估骨折愈合情况,测量桡骨高度、掌倾角及尺偏角,并采用Green and O’Brien腕关节评分标准评定腕关节功能。比较治疗后6周时3组患者的桡骨高度、掌倾角、尺偏角的恢复情况及治疗后12个月时的腕关节功能。结果:所有患者均未发生骨折再移位。所有骨折均获骨性愈合;3组患者的骨折愈合时间比较,差异无统计学意义[(5.9±2.9)周,(6.1±2.4)周,(6.1±1.9)周,F=3.201,P=0.089]。治疗后6周时,3组患者的掌倾角增加值比较,差异无统计学意义(12.64°±1.53°,14.08°±3.09°,14.03°±2.79°,F=2.166,P=0.121);3组患者的桡骨高度增加值比较,差异有统计学意义[(0.97±0.17)cm,(0.83±0.19)cm,(0.63±0.16)cm,F=9.473,P=0.021],A型组桡骨高度增加值大于B型组和C型组(P=0.030;P=0.002),B型组大于C型组(P=0.001);3组患者的尺偏角增加值比较,差异有统计学意义(15.60°±1.75°,16.57°±1.86°,13.76°±1.94°,F=11.483,P=0.001),A型组和B型组尺偏角增加值均大于C型组(P=0.001;P=0.029),A型组和B型组比较,差异无统计学意义(P=0.078)。治疗后12个月时3组患者的Green and O’Brien评分比较,差异有统计学意义[(88.56±2.19)分,(81.79±4.74)分,(69.68±6.01)分,F=13.619,P=0.000],A型组的评分高于B型组和C型组(P=0.011;P=0.000),B型组评分高于C型组(P=0.001)。结论:对于A、B型Colles骨折,小夹板外固定可有效维持复位后骨折端的稳定,有利于关节功能恢复;但对于C型Colles骨折,小夹板外固定效果较差。Objective：To compare the fixation effects of small splint external fixation for treatment of three types of Colles fractures. Methods：The medical records of 62 patients with Colles fractures who were treated with manipulative reduction and small splint external fixation were analyzed retrospectively. The fractures belonged to AO types A （ 9 ）, B （ 28 ） and C （ 25 ）. Manipulative reduction and small splint external fixation were performed on all of the patients according to the operation specification of distal radius fracture which was extracted from Guidelines For Diagnosis And Treatment Of Commom Diseases Of Orthopedics And Traumatology In Traditional Chinese Medicine. Fracture healing were evaluated and radial heights, volar tilt angles and radial inclination angles were measured according to the X-ray films. In addition,the wrist joints function were evaluated by using Green and O＇ Brien wrist joint scoring criterion. The recovery of radial heights, volar tilt angles and radial inclination angles were compared between the 3 groups at 6 weeks after the treatment and the wrist joints function were compared between the 3 groups at 12 months after the treatment. Results：No fracture re - displacement was found. All the pa- tients got bone union and there was no statistical difference in the fracture healing time between the 3 groups （ 5.9 ± 2.9,6.1 ± 2.4, 6.1 ± 1.9 weeks, F = 3. 201, P = 0. 089 ）. There was no statistical difference in the increase values of volar tilt angles between the 3 groups（ 12.64 ± 1.53,14.08 ± 3.09,14.03 ± 2.79 degrees, F = 2. 166, P = 0. 121 ） and there was statistical difference in the in- crease values of radial heights between the 3 groups at 6 weeks after the treatment （ 0.97 ± 0.17,0.83 ± 0.19,0.63 ± 0.16 cm, F = 9. 473 ,P =0. 021 ）. The increase values of radial heights were greater in type A group compared to type B group and type C group（ P = 0. 030;P = 0. 002 ）, and were greater in type B group compared to type C group （P = 0. 001 �

关 键 词：小夹板固定 COLLES骨折 桡骨骨折 临床试验 

分 类 号：R687.3[医药卫生—骨科学]