非手术治疗桡骨远端骨折累及中间柱对前臂旋转的影响研究  

Effect of non-operative treatment on forearm rotation in patients with distal radius fracture involving intermediate column

作　　者：王洪超[1,2] 张明伦 高志方 潘新 WANG Hong-chao;ZHANG Ming-lun;GAO Zhi-fang;PAN Xin(Department of Spinal Surgery,Qilu Hospital of Shandong University,Ji'nan 250000,China;Department of Bone Trauma,Liaocheng Hospital of Traditional Chinese Medicine,Liaocheng,Shandong 252000,China;Department of Anesthesiology,Liaocheng Hospital of Traditional Chinese Medicine,Liaocheng,Shandong 252000,China)

机构地区：[1]山东大学齐鲁医院脊柱外科,济南250000 [2]聊城市中医院骨创伤科,山东聊城252000 [3]聊城市中医院麻醉科,山东聊城252000

出　　处：《创伤外科杂志》2020年第8期613-616,共4页Journal of Traumatic Surgery

摘　　要：目的分析累及桡骨远端中柱骨折经非手术治疗对前臂旋转功能的影响。方法回顾性分析2015年1月—2018年12月山东大学齐鲁医院脊柱外科收治的104例经非手术治疗的桡骨远端骨折患者资料,男性42例,女性62例;年龄25~66岁,平均52. 5岁;18例为A2型骨折,34例为A3型,18例为C1型,34例为C2型。患者均石膏固定2周后,改患肢功能位再固定2~4周。按照骨折位置分为两组,病例组为累及中柱骨折,对照组不累及中柱骨折,每组各52例。分析两组患者腕部运动及握力的差异,加特兰和韦利得分,臂、肩、手残疾(DASH)评分;12个月时VAS评分。采用配对t检验比较连续变量间的差异,采用线性回归分析或Pearson相关分析评价放射学参数(掌倾角、尺倾角)与临床结果的相关性。结果两组患者在性别、年龄、骨折类型及骨折部位之间比较差异无统计学意义(P=0. 781,P=0. 454,P=0. 163)。两组患者旋前[病例组(77. 0±7. 8)°vs.对照组(82. 8±7. 3)°,P=0. 000]和旋后[病例组(72. 0±7. 4)°vs.对照组(74. 9±8. 7)°,P=0. 008]的关节活动度(ROM)差异有统计学意义,对照组的活动度明显大于病例组。两组DASH评分差异有统计学意义(P=0. 024)。采用Pearson相关分析,观察关节脱位与内旋活动度呈负相关(r=-0. 360,P=0. 000)。线性回归分析也表明,内旋活动度与关节脱位呈负相关(β=-6. 327,P=0. 001)。结论桡骨远端累及中柱骨折经非手术治疗后,对前臂旋转有不良影响。Objective To analyze the effect of non-surgical treatment on the rotation function of the forearm in the distal radius fracture involving intermediate column. Methods Data of 104 patients with non-surgical treatment of distal radius fractures were retrospectively analyzed,who were treated in Department of Spinal Surgery in Qilu Hospital of Shandong University from Jan. 2015 to Dec. 2018. There were 42 males and 62 females,with an average age of 52. 5 years( range,25-66 years). Eighteen patients had type A2 fracture,34 patients had type A3,18 patients had type C1,and 34 patients had type C2. After the patients were fixed with cast for 2 weeks,the functional position of the affected limb was changed and fixed for 2 to 4 weeks. Patients were divided into two groups according to fracture location,the patients in the case group were involved in the middle column fracture,and patients in the control group was not involved in the middle column fracture,with 52 cases in each group. The differences in wrist movement and grip strength were analyzed between the two groups,Gartland-werley scores,Arm,Shoulder,and Hand Disability( DASH) scores;and Visual Analogue Scale( VAS) at postoperative 12 months were observed. Differences between continuous variables were compared using a paired t test. Linear regression analysis or Pearson correlation analysis was used to evaluate the correlation between radiological parameters( carp angle,ulnar angle) and clinical results. Results There was no significant differences between the two groups in terms of gender,age and fracture site( P = 0. 143,P = 0. 454 and P = 0. 375). The range of motion( ROM) for pronation [case group( 77. 0± 7. 8) ° vs. control group( 82. 8 ± 7. 3) °,P < 0. 001] and supination [case group( 72. 0 ± 7. 4) ° vs. control group( 74. 9 ± 8. 7) °,P = 0. 008]had a significant difference between the two groups. There was a significant difference in DASH scores( P = 0. 024) between the two groups. Pearson correlation analysis showed negative correlations( r =-0. 360,P

关 键 词：桡骨远端骨折 中柱骨折 非手术 

分 类 号：R683.41[医药卫生—骨科学]