腕功能位固定治療伸直型橈骨遠(yuǎn)端粉碎性骨折的臨床觀察

梁輝

[摘要] 目的 探討手法復(fù)位后采用改良的腕功能位固定治療伸直型橈骨遠(yuǎn)端粉碎性骨折的療效并與傳統(tǒng)夾板固定進(jìn)行比較。 方法 選擇2008年2月～2013年1月160例伸直型橈骨遠(yuǎn)端粉碎性骨折患者，隨機(jī)分為實(shí)驗(yàn)組（I）及對(duì)照組（Ⅱ）。實(shí)驗(yàn)組采用腕功能位石膏托外固定3周，3周后改為夾板外固定；而對(duì)照組應(yīng)用傳統(tǒng)夾板掌屈尺偏位固定，兩組均固定至臨床愈合，觀察其臨床療效。 結(jié)果 160例患者均獲隨訪，隨訪時(shí)間10～45個(gè)月，平均28個(gè)月；根據(jù)X線和腕關(guān)節(jié)功能評(píng)估，實(shí)驗(yàn)組優(yōu)良率達(dá)96.3%，對(duì)照組80.0%；兩組臨床療效及影像學(xué)比較差異有統(tǒng)計(jì)學(xué)意義（P <0.05）。結(jié)論 改良的腕功能位外固定治療伸直型橈骨遠(yuǎn)端粉碎性骨折較傳統(tǒng)夾板方法為好。

[關(guān)鍵詞] 伸直型；橈骨遠(yuǎn)端粉碎性骨折；改良外固定；腕功能位

[中圖分類號(hào)] R687.3 [文獻(xiàn)標(biāo)識(shí)碼] B [文章編號(hào)] 1673-9701（2014）11-0149-03

[Abstract] Objective To treat extension type distal radius comminuted fractures by improved function wrists position fixation after manipulative reduction，and compared with the traditional splint. Methods A total of 160 patients with distal radial comminuted fracture were divided into two groups from February 2008 to January 2013，patients in groupⅠreceived treatment of function wrists position fixation with plaster fixation， after 3 weeks， plaster external fixation was changed with splint external fixation on wrist function position；patients in groupⅡreceived treatment of traditional volar tilt and ulnar deviation angle with splint external fixation，the clinical effect was compared after Clinical healing.Results All the patients were followed up for 10 to 45 months， mean 28 months；The fracture all healed on clinical.Accordingto Denist functional evaluation system and regularly X-ray after manipulative reduction， the good-excellent rate of groupⅠwas 96.3%，and was 80.0% of groupⅡ. The effective rate was significantly superior to that of group I，there are Significance in Statistics on clinical effect and Imaging Assessment between two groups（P <0.05）. Conclusion The outcome of improved wrists position of function fixation is better than that of traditional splint on the function and radiology for treating extension type distal radius comminuted fractures.

[Key words] Extension type；Distal radius comminuted fractures；Improved external fixation；Functional wrists position

筆者自2008年2月～2013年1月對(duì)160例伸直型橈骨遠(yuǎn)端粉碎性骨折閉合手法復(fù)位后采用改良的腕功能位外固定處理，取得較好療效。報(bào)道如下。

1 資料與方法

1.1一般資料

2008年2月～2013年1月共收治橈骨遠(yuǎn)端粉碎性骨折患者160例，男64例，女96例，年齡36～88歲，平均63.5歲。受傷至就診時(shí)間為0.5 h～2 d，平均0.5 d。受傷原因：交通意外傷40例，跌倒96例，墜落傷24例。均為新鮮骨折。依據(jù)AO/ASIF對(duì)骨折類型進(jìn)行分類，90例為C2型，70例為C3型。

1.2 病例選擇

診斷標(biāo)準(zhǔn)參照實(shí)用骨科學(xué)[1]，分型根據(jù)X線片按橈骨遠(yuǎn)端骨折的AO分類法分型。納入標(biāo)準(zhǔn)：符合以上診斷標(biāo)準(zhǔn)，同意接受以手法復(fù)位、改良腕關(guān)節(jié)功能位外固定治療，并能按醫(yī)囑定期復(fù)診至臨床愈合，配合功能鍛煉及接受隨訪及療效評(píng)價(jià)。排除標(biāo)準(zhǔn)：不符合診斷及納入標(biāo)準(zhǔn)；開放性骨折；……