手法复位经皮克氏针治疗老年不稳定性桡骨远端骨折的疗效观察  

Observation on the therapeutic effect of manual reduction and percutaneous K-wire treatment for unstable distal radius fractures in the elderly patients

作　　者：谭丹 周勇 湛小波 鲍全伟 Tan Dan;Zhou Yong;Zhan Xiaobo;Bao Quanwei(Emergency Trauma Center,the Second Hospital Affiliated to Army Medical University,Chongqing 400037,China)

机构地区：[1]陆军军医大学第二附属医院急诊创伤中心,重庆400037

出　　处：《中国急救医学》2024年第10期850-855,共6页Chinese Journal of Critical Care Medicine

基　　金：重庆市体育局科研项目(C202212)。

摘　　要：目的探讨手法复位经皮克氏针治疗老年不稳定性桡骨远端骨折手术方法和临床疗效。方法回顾性分析2022年12月至2023年10月陆军军医大学第二附属医院急诊科采用手法复位经皮克氏针治疗的45例老年不稳定性桡骨远端骨折,同时间段收治采用切开复位钢板内固定的45例老年不稳定性桡骨远端骨折患者作为对照组。手法复位克氏针内固定手术方法为臂丛麻醉下手法牵拉复位桡骨远端骨折;C臂透视下一枚克氏针于尺骨远端经皮进针,经下尺桡关节沿软骨下骨锁定桡骨远端以维持桡骨远端复位高度及掌倾角,再由桡骨远端茎突侧经皮穿入克氏针以维持桡骨远端尺偏角,由桡骨远端背侧经皮穿入克氏针撬拨复位及固定粉碎骨折块;最后剪断克氏针尾端并埋于皮下,术后定期随访,术后6~8周视情况拔出克氏针。对照组手术方法为常规Henry入路,直视下复位骨折并桡骨远端钢板固定。观察两组患者骨折愈合情况、功能恢复状况及并发症。结果所有患者均获得随访,骨折愈合时间平均3.8(3,5)个月。与采用切开复位内固定治疗的患者相比,手法复位克氏针内固定治疗患者住院费用明显降低(元:34179.70±4000.00 vs.4220.56±500.00,P<0.01),住院时间明显缩短(d:7.2±1.5 vs.1.2±0.2,P<0.01);术后4个月随访时腕关节功能Gartland-Werley评分优良率差异无统计学意义(95.6%vs.97.8%,P>0.05),快速上肢功能障碍评定量表(DASH)评分差异无统计学意义(分:9.89±3.43 vs.9.64±3.36,P>0.05)。结论老年不稳定性桡骨远端骨折患者经手法复位克氏针固定下尺桡关节而获得二次稳定,方法简便易行,费用低廉,疗效肯定,值得运用推广。Objective To explore the surgical method and clinical efficacy of manual reduction and percutaneous K-wire fixation for unstable distal radius fractures in the elderly patients.Methods A retrospective analysis was conducted on 45 elderly patients with unstable distal radius fractures treated with manual reduction and percutaneous K-wire fixation from December 2022 to October 2023 in Emergency Medicine department of the Second Hospital Affiliated to Army Medical University,and another 45 elderly patients with unstable distal radius fractures receiving open reduction and plate internal fixation were treated as the control group at the same time.The surgical method involved manual traction reduction of distal radius fractures under brachial plexus anesthesia;under C-arm fluoroscopy,a K-wire was inserted percutaneously from the distal end of the ulna,passed through the distal radioulnar joint along the subchondral bone to lock the distal radius to maintain the height and palmar inclination angle of the distal radius,then a K-wire was inserted percutaneously from the styloid process side of the distal radius to maintain the radial deviation angle of the distal radius,and finally a K-wire could be inserted percutaneously from the dorsal side of the distal radius to pry and fix the comminuted fracture fragments;finally,the tail end of the K-wire was cut and buried under the skin,and the patients were followed up regularly,with the K-wire removed as appropriate at 6-8 weeks postoperatively.The control group was treated by the conventional Henry approach with direct view reduction and distal radius plate fixation.The healing of the fracture,the recovery of function and complications were observed in the two groups.Results The average time of fracture healing was 3.8(3,5)months.Compared with the patients treated with open reduction and plate internal fixation at the early stage,the hospitalization costs of the patients treated with manual reduction and K-wire internal fixation were significantly reduced(yuan:34179.70±4000

关 键 词：不稳定性桡骨远端骨折 克氏针 手法复位 老年 

分 类 号：R687.3[医药卫生—骨科学]