桡骨远端骨折闭合复位后再移位相关危险因素分析  

Analysis of risk factors of redisplacement after reduction and external fixation of distal radius fractures

作　　者：张妙林 高志朝[1] 郑国富[1] 孟永骏 金伟强 ZHANG Miao-lin;GAO Zhi-chao;ZHENG Guo-fu;MENG Yong-jun;JIN Wei-qiang(Department of Orthopedics,Yuhang Hospital A ffilicded to Medical College of Hangzhou formal University,Hangzhou,Zhejiang 311100,China)

机构地区：[1]杭州师范大学附属余杭医院(杭州市余杭区第一人民医院)骨科,浙江311100

出　　处：《中国骨与关节损伤杂志》2019年第3期262-265,共4页Chinese Journal of Bone and Joint Injury

摘　　要：目的探讨桡骨远端骨折闭合复位后再移位的相关危险因素以及对策。方法回顾性分析自2014-01—2016-01行闭合复位石膏外固定的272例桡骨远端骨折,闭合复位成功且非手术治疗成功者纳入A组。随访期间出现关节面移位>2 mm、桡骨长度短缩>3 mm、尺偏角<20°、掌倾角<10°即认为复位后骨折再移位者纳入B组。结果 272例均获得随访,随访时间平均5.3(4～6)个月。205例纳入A组,67例纳入B组。A组与B组在性别、年龄、桡骨粉碎性骨折、骨质疏松方面比较差异无统计学意义(P>0.05)。在致伤原因方面,A组摔伤比例更高,而B组交通事故伤和机械伤比例更高;在骨折AO分型方面,B组C1、C3型骨折比例高于A组;在尺骨完整性方面,B组尺骨粉碎性骨折比例高于A组,差异均有统计学意义(P<0.05)。结论桡骨远端骨折闭合复位后因存在高能量损伤、尺骨稳定性缺失、骨折粉碎等相关危险因素,常导致复位后骨折再移位,在临床中遇到此类患者是需要预见复位失败、骨折再移位及二次手术风险,能有效避免关节功能障碍,避免医疗纠纷。Objective To investigate and analyze the risk factors of redisplacement after reduction and external fixation of distal radius fracture. Methods Two hundred and seventy-two patients with reduction and external fixation of distal radius fractures from January 2014 to January 2016 were retrospectively reviewed. All patients were divided into two groups, patients with success of close redution without operation were included in group A while patients with displacement of articular surface > 2 mm, radial length shortening >3 mm, ulnar deflection angle <20°, radial incline <10°) during the follow-up were in group B. Results All 272 patients were followed up for 4 to 6 months, average 5.3 months. Two hundred and five patients were included in group A, 67 patients were included in group B. The difference was not statistically significant in gender, age, comminuted fracture of radius, osteoporosis (P >0.05). The group B was more resulted from traffic accident, machine injury while most cases in group A were resulted from falling down. According to AO classification, Cl, C3 type can easy to cause redisplacement (P <0.05). According to the complete of ulna, the comminuted ulnar fracture can easy to cause redisplacement (P <0.05). Conclusion The distal radius fractures can be easy to cause redisplacement after reduction due to high energy injury, the loss of ulnar stability, comminuted fracture. The failure of reduction, reduction redisplacement and reoperation should be predicted in clinical practice, and this can prevent disorder of wrist joint, and medical disputes.

关 键 词：桡骨远端骨折 闭合复位 骨折再移位 危险因素 

分 类 号：R683.41[医药卫生—骨科学]