带沟槽夹板固定老年桡骨远端骨折对患肢早期肿胀和血流速度的影响  

Effect of groove splint fixation on early swelling and blood flow velocity of the injury limb in elderly patients with distal radius fractures

作　　者：陈波涛 潘莎 杨利 CHEN Bo-tao;PAN Sha;YANG Li(Department of Orthopaedics,Jiulongpo Hospital of Traditional Chinese Medicine,Chongqing400080,China;JiulongpoHospitalof Chongqing College of Traditional Chinese Medicine,Chongqing400050,China;Department of Ultrasound,Jiulongpo Hospital of Traditional Chinese Medicine,Chongqing400080,China)

机构地区：[1]重庆市九龙坡区中医院骨伤科,重庆400080 [2]重庆中医药学院附属九龙坡医院,重庆400050 [3]重庆市九龙坡区中医院超声科,重庆400080

出　　处：《中国骨伤》2024年第10期953-958,共6页China Journal of Orthopaedics and Traumatology

基　　金：重庆市九龙坡区科技局基础研究与成果转化类科技计划项目(编号:2021-02-008-Y);重庆市中医药重点学科建设项目(编号:渝中医〔2019〕11号);重庆市科卫联合中医药科技项目(编号:ZY201802002)。

摘　　要：目的:观察老年患者桡骨远端骨折采取带沟槽夹板固定,对患肢早期手部肿胀、血流速度及临床功能的影响。方法:自2021年3月至2022年2月,采取手法复位夹板外固定治疗单侧闭合性桡骨远端骨折64例,男10例,女54例,年龄60~78(67.7±4.7)岁。按入院顺序依次分为沟槽夹板组、常规夹板组,每组各32例。其中,沟槽夹板组男4例,女28例;年龄(68.6±4.8)岁;左侧13例,右侧19例;AO分型,A型22例,C型10例;受伤至治疗时间3.0(2.0,4.0)h。常规夹板组男6例,女26例;年龄(66.9±4.4)岁;左侧17例,右侧15例;AO分型,A型20例,C型12例;受伤至治疗时间3.0(2.0,5.5)h。两组分别在骨折手法复位后采取带沟槽夹板、常规夹板进行固定,记录两组临床资料,测量两组双上肢术后1、3、7、14 d手背周径,肿胀值为患肢和健侧周径差,双上肢1、3、7 d掌浅弓、掌背静脉血流速度值,复位前和术后3个月X线片的桡骨茎突高度、掌倾角、尺偏角,以及术后3、12个月臂、肩、手功能障碍(disabilities of the arm,shoulder,and hand,DASH)评分,并进行统计学分析。结果:沟槽夹板组掌部肿胀值在第3、7、14天时(1.897±0.071)、(1.200±0.169)、(0.994±0.085)cm,较常规夹板组(2.283±0.268)、(1.893±0.269)、(1.183±0.126)cm改善(P<0.001)。夹板固定后第1、3天,沟槽夹板组掌浅弓血流速度差(0.017±0.009)、(0.018±0.011)L·min-1,低于常规夹板组(0.023±0.011)、(0.025±0.013)L·min-1(P<0.05);第7天差异无统计学意义(P>0.05)。掌背静脉血流速度差值比较,夹板固定后第1天,两组差异无统计学意义(P>0.05);第3、7天沟槽夹板组血流速度差值(0.037±0.019)、(0.021±0.013)L·min-1,低于常规夹板组(0.062±0.033)、(0.037±0.022)L·min-1(P<0.05)。复位前后桡骨远端掌倾角、尺偏角、桡骨高度比较差异均无统计学意义(P>0.05)。术后3个月随访时沟槽夹板组DASH评分(6.1±2.8)分,小于常规夹板组(8.2±3.7)分(P<0.05);术后12个月时两组比�Objective To observe the effects of groove splint fixation on early hand swelling,blood flow velocity,and clinical function in elderly patients with distal radius fractures.Methods Between March 2021 and February 2022,64 patients of unilateral closed distal radius fractures were treated with manual reduction and external fixation with splints.There were 10 males and 54 females,the age ranged from 60 to 78 years old,with an average age of(67.7±4.7)years old.According to the order of admission,the patients were divided into the groove splint group and the conventional splint group,with 32 cases in each group.In the groove splint group,there were 4 males and 28 females,with an average age of(68.6±4.8)years old.There were 13 patients with left-sided fractures,and 19 patients with right-sided fractures,with 22 cases classified as AO type A and 10 cases as AO type C.The mean time from injury to treatment was 3.0(2.0,4.0)h.In the conventional splint group,there were 6 males and 26 females,with an average age of(66.9±4.4)years old.There were 17 patients with left-sided fractures and 15 patients with right-sided fractures,with 20 cases classified as AO type A and 12 cases as AO type C.The mean time from injury to treatment was 3.0(2.0,5.0)h.After manual reduction,patients were treated with groove splint or conventional splint.Swelling,assessed by the difference in limb circumference between the injured and healthy limbs,was measured at 1,3,7,and 14 days post-treatment.Blood flow velocities in the superficial palmar arch and dorsal metacarpal veins were measured at 1,3,and 7 days post-treatment.Radiographic evaluations of radial styloid height,palmar tilt,and ulnar variance were performed preoperatively and 3 months post-treatment.Functional outcomes were assessed using the DASH(Disabilities of the Arm,Shoulder,and Hand)score 3 and 12 months post-treatment.Statistical analyses were conducted to compare the outcomes between the two groups.Results All 64 patients were followed up for the least 12 months.The swelling value

关 键 词：夹板 桡骨远端骨折 保守治疗 血流速度 肿胀 

分 类 号：R683.4[医药卫生—骨科学]