老年伸直型桡骨远端骨折手法复位夹板外固定治疗后骨折移位的危险因素分析  

Analysis of risk factors for fracture displacement after manipulative reduction and splint external fixation fortreatment of straighten distal radius fractures in the aged

作　　者：莫军杰 孙奇 周君鹏 裘晓东 孙晓 陈金洪 张玉良 MO Junjie;SUN Qi;ZHOU Junpeng;QIU Xiaodong;SUN Xiao;CHEN Jinhong;ZHANG Yuliang(Fuyang TCM Orthopedic-Traumatological Hospital,Hangzhou 311400,Zhejiang,China)

机构地区：[1]杭州市富阳中医骨伤医院,浙江杭州311400

出　　处：《中医正骨》2021年第8期12-15,共4页The Journal of Traditional Chinese Orthopedics and Traumatology

基　　金：杭州市科技计划引导项目(20181228Y146)。

摘　　要：目的:探讨老年伸直型桡骨远端骨折手法复位夹板外固定治疗后骨折移位的危险因素。方法:选择298例采用手法复位夹板外固定治疗的老年伸直型桡骨远端骨折患者,从病历系统中提取性别、就诊年龄、受伤至就诊时间、患侧是否为利手侧、治疗前桡骨短缩程度和掌倾角、桡骨远端背侧是否粉碎、是否合并尺骨茎突骨折、固定后患肢是否悬吊、是否联合口服中药治疗、外固定时间及骨折移位情况等信息。按照骨折移位情况将患者分为移位组和未移位组,先对2组患者的相关信息进行单因素分析,然后对筛选出的因素进行Logistic多因素回归分析。结果:移位组60例,未移位组238例。2组患者的性别、患侧为利手侧、桡骨短缩、掌倾角、桡骨远端背侧粉碎、尺骨茎突骨折情况比较,组间差异均有统计学意义(χ^(2)=20.560,P=0.000;χ^(2)=4.387,P=0.036;t=-6.650,P=0.000;t=3.423,P=0.001;χ^(2)=65.971,P=0.000;χ^(2)=117.720,P=0.000);2组患者的年龄、受伤至就诊时间、患肢悬吊、外固定时间及口服中药治疗情况比较,组间差异均无统计学意义(t=0.610,P=0.542;χ^(2)=0.614,P=0.433;χ^(2)=0.007,P=0.931;χ^(2)=0.308,P=0.579;χ^(2)=0.088,P=0.767)。Logistic多因素回归分析显示,性别、桡骨短缩、桡骨远端背侧粉碎、尺骨茎突骨折均为老年伸直型桡骨远端骨折手法复位夹板外固定治疗后骨折移位的危险因素(P=0.018,OR=3.634;P=0.039,OR=1.369;P=0.000,OR=5.167;P=0.000,OR=13.763)。结论:性别、桡骨短缩、桡骨远端背侧粉碎、尺骨茎突骨折是老年伸直型桡骨远端骨折手法复位夹板外固定治疗后骨折移位的危险因素。Objective:To explore the risk factors for fracture displacement in the aged patients who undergo manipulative reduction and splint external fixation for treatment of straighten distal radius fractures(DRFs).Methods:Two hundred and ninety-eight aged patients who underwent manipulative reduction and splint external fixation for treatment of straighten DRFs were selected, and their information about gender, age, time from injury to visiting, the affected side in handedness side or not, pretreatment radial shortening degree and volar tilt angle, distal radius fractures(DRFs)with dorsal comminution or not, combining with ulnar styloid fractures(USFs)or not, suspension of the affected limbs or not after fixation, treatment with oral application of TCM or not, external fixation time and fracture displacement were extracted from the electronic medical record system(EMRS)for analysis.All patients were divided into the displaced group(60 cases)and undisplaced group(238 cases)according to whether the fracture displacement happened after manipulative reduction and splint external fixation.The single-factor analysis was conducted on the extracted information for screening the risk factors affecting fracture displacement, followed by logistic multi-factor regression analysis on the screened risk factors.Results:There was statistical difference in gender, affected side in handedness side, radial shortening, volar tilt angle, dorsally comminuted DRFs, USFs between the 2 groups(χ2=20.560,P=0.000;χ2=4.387,P=0.036;t=-6.650,P=0.000;t=3.423,P=0.001;χ2=65.971,P=0.000;χ2=117.720,P=0.000);while there was no statistical difference in age, time from injury to visiting, suspension of affected limb, external fixation time and oral application of TCM between the 2 groups(t=0.610,P=0.542;χ2=0.614,P=0.433;χ2=0.007,P=0.931;χ2=0.308,P=0.579;χ2=0.088,P=0.767).The results of logistic multi-factor regression analysis revealed that the gender, radial shortening, dorsally comminuted DRFs and USFs were the risk factors for fracture displacemen

关 键 词：COLLES骨折 正骨手法 小夹板固定 危险因素 Logistic模型 

分 类 号：R274.1[医药卫生—中医骨伤科学]