老年桡骨远端骨折的治疗方法

The treatment of distal radius fractures in aged patients

目的探讨老年桡骨远端骨折的治疗方法及临床疗效。方法1999年1月～2004年3月,采用非手术及手术治疗老年桡骨远端骨折171例,男31例,女140例;年龄60～76岁,平均67.3岁。手术组95例,男19例,女76例;年龄60～76岁,平均69.1岁。按AO桡尺骨远端骨折的分型:B1型7例,B2型12例,B3型8例,C1型27例,C2型22例,C3型19例。非手术组76例,男12例,女64例;年龄60～69岁,平均65.1岁。按AO桡尺骨远端骨折的分型:A2型35例,A3型24例,B1型5例,B2型4例,B3型3例,C1型2例,C2型1例,C3型2例。A型骨折首选闭合复位加石膏托外固定;对B型和C1型骨折在闭合复位不满意时首选切开复位“T”形纯钛金属板钉内固定;对C2和C3型骨折首选切开复位“T”形纯钛金属板钉内固定,当干骺端骨折线邻近关节面无法使用“T”形纯钛金属板钉固定时,采用切开复位外固定架固定,并根据术中复位的情况决定是否加克氏针内固定。此外对于骨质疏松严重的病例可选用带锁加压钢板内固定。结果非手术组76例,23例获得随访,随访时间4～22个月,平均7个月;手术组95例均获得随访,随访时间3～20个月,平均6.5个月。X线显示骨折全部愈合。根据Aro关于Colles骨折复位后的功能评价:非手术组,优11例、良9例、可1例、差2例,优良率为86.9%;手术组,优46例、良40例、可7例、差2例。

Objective To evaluate the treatment method and clinical outcome of the aged distal radius fractures. Methods 171 cases with fractures of distal radius from January 1999 to March 2004 were analysed. There were 31 males and 140 females(mean age, 67.3 years; range, 60-76 years). The fractures were classified according to the AO classification of distal radial fracture: 7 B1, 12 B2, 8 B3, 27 C1, 22 C2 and 19 C3. The operation group included 95 patients, 19 males and 76 females(mean age, 69.1 years; range, 60-76 years). 45 were on the left side and 50 on the right side. The non-operation group included 76 patients, 12 males and 64 females(mean age, 65.1 years; range, 60-69 years). 34 were on the left side and 42 on the right side. The fractures type were the following: 35 A2, 24 A3, 5 B1, 4 B2, 3 B3, 2 C1, 1 C2 and 2 C3. For the type A fractures, the priority of treatment was the close reduction and plaster immobilization; for the type B and C1 fractures, it was the open reduction and 'T' titanium plate fixation when the close manipulation failed; for the type C2 and C3 fractures, the 'T' titanium plate fixation would take the precedence of other methods; and when the fractures were closed to the joints, the external fixator would take the place of plate. Furthermore, the locking compression plate could be selected for the severe osteoporosis. Results Only 22 cases of patients were followed-up in the non-operation group(mean 7 months; range, 4-22 months); but all of 95 operated patients were followed-up(mean 6.5 months; range, 3-20 months). The fractures all healed on X-ray. According to Aro's evaluation of the distal radial fracture, in the non-operation group, there were 11 excellent, 9 good, 1 fair and 2 poor, the good-excellent rate was 86.9%; while in the operation group there were 46 excellent, 40 good, 7 fair and 2 poor, the good-excellent rate was 90.6%. Conclusion The different methods of treatment should be used for distal radial fracture according to the patient types. In case of the fracture and deformity in the articular surface or severe comminuted fracture in the metaphysis of the distal radius, the operation is indicated; and the manipulation can be used in simple metaphysis fractures with a good bone quality.