摘要
目的：比较手法复位石膏外固定和切开复位钢板内固定治疗骨质疏松性桡骨远端骨折的临床疗效和安全性。方法：回顾性分析73例骨质疏松性桡骨远端骨折患者的病例资料，其中采用手法复位石膏外固定44例，采用切开复位钢板内固定29例。男32例，女41例；年龄60～79例，中位数69岁；左侧27例，右侧46例；按照桡骨远端骨折的 AO 分类，A3型18例、B2型8例、B3型12例、C1型19例、C2型16例。记录并比较2组患者骨折愈合时间、掌倾角和尺偏角及并发症发生情况。记录并比较2组患者骨折愈合时及骨折愈合后6个月的前臂旋前角度、前臂旋后角度及 Robbins 腕关节评分。结果：手法复位石膏外固定组骨折愈合时间、掌倾角、尺偏角均小于切开复位钢板内固定组[（9．75±1．04）周，（11．83±0．75）周，t ＝17．280，P ＝0．001；9．88＆#176;±1．47＆#176;，12．43＆#176;±1．27＆#176;，t ＝10．509，P ＝0．007；21．13＆#176;±0．85＆#176;，22．72＆#176;±0．66＆#176;，t ＝14．350，P ＝0．003]。骨折愈合时手法复位石膏外固定组前臂旋前、旋后角度及 Robbins 腕关节评分均低于切开复位钢板内固定组[25．63＆#176;±6．72＆#176;，51．17＆#176;±8．93＆#176;，t ＝37．555，P ＝0．000；22．13＆#176;±4．58＆#176;，51．33＆#176;±5．72＆#176;，t ＝113．150，P ＝0．000；（3．88±0．64）分，（6．00±0．59）分，t ＝67．632，P ＝0．000]；骨折愈合后6个月2组患者前臂旋前、旋后角度及 Robbins 腕关节评分比较，组间差异均无统计学意义[77．50＆#176;±6．74＆#176;，81．50＆#176;±4．60＆#176;，t ＝1．554，P ＝0．236；73．63＆#176;±5．71＆#176;，73．50＆#176;±1．87＆#176;，t ＝0．003，P ＝0．960；（7．63±0．92）分，（8．00±1．06）分，t ＝1．479，P ＝0．236]。2组患者并发症发生率比较，差异无统计学意义（χ2＝0．052，P ＝0．820）。结论：对于骨质疏松性桡骨远端骨折患者而言，在骨折复位以及骨折愈合时的腕关节活动能力和功能方面，切开复位钢板内固定优于手法复位石膏外固定；但手法复位石膏外固定的骨折愈合时间短，且骨折愈合后6个月的腕关节功能及安全性方面与切开复位钢板内固定无明显差异，符合老年患者的治疗要求，可作为临床治疗骨质疏松性桡骨远端骨折的一种较为理想的选择。
Objective：To compare the clinical curative effect and safety of manual reduction and plaster external fixation versus open reduction and plate internal fixation in the treatment of osteoporotic distal radius fractures（ODRF）.Methods：The medical records of 73 pa-tients with ODRF were analyzed retrospectively.Forty-four patients were treated with manual reduction and plaster external fixation,while the others were treated with open reduction and plate internal fixation.The patients consisted of 32 males and 41 females,and ranged in age from 60 to 79 years（Median =69 yrs）.The fractures located in left radius for 27 patients and right radius for 46 patients.According to the AO classification of distal radius fracture,the fractures belonged to types A3（18）,B2（8）,B3（12）,C1 （19）and C2（16）.The fracture healing time,volar tilt angles,radial inclination angles and complications were recorded and compared between the 2 groups.The antebrachi-al pronation angles,antebrachial supination angles and Robbins wrist scores were also recorded and compared between the 2 groups when the fractures healed and at 6 months after the fracture healing.Results：Fracture healing time,volar tilt angles and radial inclination angles were less in manual reduction and plaster external fixation group compared to open reduction and plate internal fixation group（9.75 ＋/-1.04 vs 11.83 ＋/-0.75 weeks,t =17.280,P =0.001;9.88 ＋/-1.47 vs 12.43 ＋/-1.27 degrees,t =10.509,P =0.007;21.13 ＋/-0.85 vs 22.72 ＋/-0.66 degrees,t =14.350,P =0.003）.Antebrachial pronation angles,antebrachial supination angles and Robbins wrist scores were less in manual reduction and plaster external fixation group compared to open reduction and plate internal fixation group when the frac-tures healed（25.63 ＋/-6.72 vs 51.17 ＋/-8.93 degrees,t =37.555,P =0.000;22.13 ＋/-4.58 vs 51.33 ＋/-5.72 degrees,t =113.150,P =0.000;3.88 ＋/-0.64 vs 6.00 ＋/-0.59 points,t =67.632,P =0.000）.There was no statistical difference in antebrachial pronation angles,antebrachial supination angles and Robbins wrist scores between the 2 groups at 6 months after the fracture healing （77.50 ＋/-6.74 vs 81.50 ＋/-4.60 degrees,t =1.554,P =0.236;73.63 ＋/-5.71 vs 73.50 ＋/-1.87 degrees,t =0.003,P =0.960;7.63 ＋/-0.92 vs 8.00 ＋/-1.06 points,t =1.479,P =0.236）.There was no statistical difference in complication incidences between the two groups（χ2 =0.052,P =0.820）.Conclusion：For patients with ODRF,open reduction and plate internal fixation surpasses manual re-duction and plaster external fixation in fracture reduction,daily activity and function of wrist when the fracture healed.However,shorter frac-ture healing time can be obtained by using manual reduction and plaster external fixation,and there is no significant difference in wrist joint function and safety between the 2 therapies at 6 months after the fracture healing.Therefore,the therapy of manual reduction and plaster ex-ternal fixation can meet the requirement for treatment of aged patients and can be used as an ideal therapy for treatment of ODRF in clinic.
出处
《中医正骨》
2015年第4期15-20,共6页
The Journal of Traditional Chinese Orthopedics and Traumatology
基金
国家自然科学基金项目(81173282)
关键词
桡骨骨折
骨质疏松性骨折
正骨手法
石膏
外科
骨折固定术
内
内固定器
治疗
临床研究性
radius fractures
osteoporotic fractures
bone setting manipulation
casts, surgical
fracture fixation, internal
internal fixators
therapies, investigational
