外固定架外固定弯针撬拨治疗粉碎性Colles骨折的临床研究  

A clinical study of frame external fixation combined with curved needle leverage reduction for treatment of comminuted Colles fractures

作　　者：许晶晶 成永忠[1] 程灏[1] 黄晓宇 贺达 陈洋 蔡静怡[1] 温建民[1] 聂伟志 XU Jingjing;CHENG Yongzhong;CHENG Hao;HUANG Xiaoyu;HE Da;CHEN Yang;CAI Jingyi;WEN Jianmin;NIE Weizhi(Wangjing Hospital of China Academy of Chinese Medical Sciences,Beijing 100102,China;The Wendeng Osteopath Hospital,Weihai 264400,Shandong,China)

机构地区：[1]中国中医科学院望京医院,北京100102 [2]山东省文登整骨医院,山东威海264400

出　　处：《中医正骨》2019年第10期12-16,20,共6页The Journal of Traditional Chinese Orthopedics and Traumatology

基　　金：首都临床特色研究与应用推广项目(Z161100000516111)

摘　　要：目的:探讨外固定架外固定弯针撬拨治疗粉碎性Colles骨折的临床疗效。方法:对2016年6月至2018年6月,分别采用外固定架外固定弯针撬拨和切开复位钢板内固定治疗的38例粉碎性Colles骨折患者的病例资料进行回顾性分析。采用外固定架外固定弯针撬拨治疗18例(外固定弯针撬拨组),采用切开复位钢板内固定治疗20例(钢板内固定组)。观察骨折愈合情况。在术前、术后1d、术后12周的X线片上测量2组患者患腕桡骨远端掌倾角。对比两组患者末次随访时采用Gartland-Werley腕关节评分标准评价的患腕功能。结果:2组患者均获随访,随访时间3~14个月,中位数4个月。38例患者骨折均愈合,外固定弯针撬拨组骨折愈合时间5~8周,中位数6周;钢板内固定组骨折愈合时间6~10周,中位数8周;外固定弯针撬拨组骨折愈合时间短于钢板内固定组(Z=-2.819,P=0.005)。患腕桡骨远端掌倾角,时间因素和分组因素不存在交互效应(F=0.181,P=0.755);2组患者患腕桡骨远端掌倾角总体比较,组间差异有统计学意义,即存在分组效应(F=7.853,P=0.008);手术前后不同时间点患腕桡骨远端掌倾角的差异有统计学意义,即存在时间效应(F=54.373,P=0.000);术前2组患者患腕桡骨远端掌倾角的差异无统计学意义(-17.6°±35.0°,-20.7°±15.4°,Z=-1.169,P=0.242),术后1d、术后12周时外固定弯针撬拨组患腕桡骨远端掌倾角均大于钢板内固定组(11.7°±6.2°,6.6°±7.1°,t=2.362,P=0.024;13.7°±9.7°,9.5°±5.4°,Z=-2.924,P=0.003)。末次随访时,外固定弯针撬拨组患腕Gartland-Werley评分(4.17±3.28)分,优8例、良8例、可2例;钢板内固定组患腕Gartland-Werley评分(3.60±3.60)分,优11例、良6例、可3例;2组患腕功能评价结果的差异无统计学意义(Z=-0.419,P=0.675)。结论:外固定架外固定弯针撬拨治疗粉碎性Colles骨折,与切开复位钢板内固定相比,骨折愈合时间短,更有利于桡骨远端掌倾角的恢�Objective: To explore the clinical curative effects of frame external fixation combined with curved needle leverage reduction for treatment of comminuted Colles fractures. Methods: The medical records of 38 patients with comminuted Colles fractures were analyzed retrospectively. Eighteen patients were treated with frame external fixation combined with curved needle leverage reduction( group A),while the others were treated with open reduction combined with plate internal fixation( group B). The fracture healing was observed. The distal radius volar tilt angle of affected wrist was measured on X - ray film taken before the surgery,at 1 day and 12 weeks after the surgery. The affected wrist functions were evaluated according to Gartland -Werley wrist function scoring standard at the last follow - up and were compared between the 2 groups. Results: All patients in the 2 groups were followed up for 3 - 14 months with a median of 4 months. All fractures healed,and the fracture healing time ranged from 5 to 8 weeks( Median = 6 weeks) in group A and ranged from 6 to 10 weeks( Median = 8 weeks) in group B. The fracture healing time was shorter in group A compared to group B( Z =- 2. 819,P = 0. 005). There was no interaction between time factor and group factor in distal radius volar tilt angle of affected wrist( F = 0. 181,P = 0. 755). There was statistical difference in distal radius volar tilt angle of affected wrist between the 2 groups in general,in other words,there was group effect( F = 7. 853,P = 0. 008). There was statistical difference in distal radius volar tilt angle of affected wrist between different timepoints before and after the surgery,in other words,there was time effect( F = 54. 373,P = 0. 000). There was no statistical difference in distal radius volar tilt angle of affected wrist between the 2 groups before the surgery(- 17. 6 +/- 35. 0 vs - 20. 7 +/- 15. 4 degrees,Z =- 1. 169,P = 0. 242). The distal radius volar tilt angles of affected wrists were larger in group A compared to group B at 1 day and 1

关 键 词：COLLES骨折 骨折 粉碎性 骨折固定术 外固定器 临床试验 

分 类 号：R687.3[医药卫生—骨科学]