三种固定方法治疗中老年桡骨远端伸直型骨折的疗效观察  

Observation on curative effect of three fixation methods for treatment of distal radius extension fractures in the middle-aged and elderly

作　　者：王楠[1] 杜国庆[2] 蔡雨卫 王辉昊[2] 曹贺 郑春伟 胡启龙 陈晶晶[1] 石瑛[2] WANG Nan;DU Guoqing;CAI Yuwei;WANG Huihao;CAO He;ZHENG Chunwei;HU Qilong;CHEN Jingjing;SHI Ying(Department of Traditional Chinese Medicine,Yangzhi Rehabilitation Hospital Affiliated to Tongji University,Shanghai 201619,China;Shi's Medical Center of Orthopedics&Traumatology,Shuguang Hospital Ajfiliated to Shanghai University of Traditional Chinese Medicine,Institute of Orthopedics&Traumatology,Shanghai Academy of Traditional Chinese Medicine,Shanghai 201203,China;Department of Orthopaedics,Shanghai Yangpu Distric Hospital of Traditional Chinese Medicine,Shanghai 200082,China)

机构地区：[1]同济大学附属养志康复医院中医科,上海201619 [2]上海中医药大学附属曙光医院石氏伤科医学中心,上海市中医药研究院骨伤科研究所,上海201203 [3]上海市杨浦区中医医院骨伤科,上海200082

出　　处：《上海中医药杂志》2021年第8期58-62,共5页Shanghai Journal of Traditional Chinese Medicine

基　　金：国家自然科学基金项目(81973871);上海市重中之重临床重点学科“中医骨伤科学”建设项目(2017ZZ02024);上海市卫健委进一步加快中医药事业发展三年行动计划海派中医流派传承工程项目(ZY[2018-2020]-CCCX-1010);上海中医药大学高峰造尖行动计划高峰高原创新中医骨伤团队项目(201723)。

摘　　要：目的观察并比较小夹板固定与石膏固定、手术切开复位钢板内固定3种方法治疗中老年桡骨远端伸直型骨折的临床疗效,并对影响小夹板固定疗效的相关因素进行分析。方法将135例中老年桡骨远端伸直型骨折患者随机分为夹板组、石膏组、手术组,每组45例。夹板组予小夹板固定,石膏组予石膏固定,手术组予手术切开复位钢板内固定。治疗后第1周、第2周、第6周时对患肢进行X线检查并决定是否拆除固定装置,并在治疗后3个月随访。观察比较X线下的掌倾角、尺偏角、桡骨短缩高度以及Cooney腕关节功能评分等级的变化情况,并采用多元线性回归法分析影响夹板组疗效的相关因素。结果(1)试验期间,3组均无病例脱落。(2)治疗前与治疗后6周组内比较,各组掌倾角、尺偏角、桡骨短缩高度水平差异均有统计学意义(P<0.05)。组间治疗后6周比较,手术组的掌倾角、桡骨短缩高度水平改善优于夹板组、石膏组(P<0.05)。(3)治疗后3个月时,夹板组、石膏组、手术组Cooney腕关节功能优良率分别为91.1%、75.6%、93.3%;组间Cooney腕关节功能优良率比较,夹板组、手术组明显优于石膏组(P<0.05)。(4)治疗前桡骨短缩高度与治疗后3个月时Cooney腕关节功能评分优良率较为相关(r=-0.584,P=0.002),即治疗前桡骨短缩高度对夹板组患者疗效的影响较大。结论3种固定方法都能较好地恢复桡骨远端骨折的掌倾角、尺偏角和桡骨短缩高度水平。小夹板固定和手术切开复位钢板内固定治疗桡骨远端伸直型骨折在恢复腕关节功能方面的疗效相当,且均优于石膏固定。治疗前桡骨短缩高度对应用小夹板固定治疗本病疗效的影响较大。Objective To observe and compare the clinical effects of small splint fixation,plaster external fixation and open reduction and plate internal fixation for treatment of distal radius extension fractures in the middle-aged and elderly,and analyze the related factors affecting the therapeutic effect of small splint fixation.Methods A total of 135 middle-aged and elderly patients with distal radius extension fractures were randomly divided into splint group,plaster group and operation group,with 45 cases in each group.The splint group was administered with small splint fixation,the plaster group was administered with plaster external fixation,and the operation group was administered with open reduction and plate internal fixation.X-ray examination was performed on the affected limb at the first week,the second week and the sixth week after treatment for the determination of whether to remove the fixation device,and the patients were followed up for 3 months after treatment.The changes of palmar tilt(PT)angle,ulnar deviation(UD)angle,radial shortening(RS)height and Cooney wrist score were observed and compared under X-ray,and the related factors affecting the therapeutic effect of splint group were analyzed by multiple linear regression method.Results(1)During the trial,there was no drop out case in the three groups.(2)According to the intra-group comparison before treatment and 6 weeks after treatment,there were significant differences in PT angle,UD angle and RS height in all groups(P<0.05).The inter-group comparison after 6 weeks of treatment showed that the improvement of PT angle and RS height in the operation group was better than that in the splint group and the plaster group(P<0.05).(3)After 3 months of treatment,the excellent and good rate of Cooney wrist score in splint group,plaster group and operation group was 91.1%,75.6%and 93.3%respectively;The excellent and good rate of Cooney wrist score in the splint group and operation group was significantly better than that in plaster group(P<0.05).(4)The height

关 键 词：小夹板固定 石膏固定 手术切开复位钢板内固定 桡骨远端骨折 伸直型 临床疗效 桡骨高度 

分 类 号：R687.3[医药卫生—骨科学]