桡骨远端骨折复位质量与腕关节功能恢复的相关性分析

The Relativity between Functional Recovery of Wrist Joint and Resetting Quality of Colles′ Fracture

目的：探讨Colles骨折手法复位质量与腕关节功能恢复之间的关系。方法：将Colles骨折患者120例通过Frykman分型制定手术或非手术治疗方案并进行干预后,随访4~20月,通过影像学方法记录治疗前后患者桡骨短缩距离、关节内骨折移位及掌倾角、尺偏角;应用Lidstrom评分系统进行解剖评分,采用Garland and Werley腕关节评分系统进行腕关节功能评分,比较2种评价标准的优良率。结果：干预后患者桡骨短缩距离为（1.62±0.34）mm,关节内骨折移位为（0.72±0.05）mm,掌倾角丢失为（0.69±3.45）°,尺偏角丢失为（6.32±2.87）°时腕关节功能恢复最佳,低于桡骨短缩距离5mm,关节内骨折移位2mm,尺偏角丢失3°,掌倾角丢失9°的传统评价标准;Garland and Werley评价显示优良率为92.5%,与Lidstrom评价的优良率94.17%相当（P〉0.05）。结论：桡骨远端骨折手法复位质量越高,则腕关节功能恢复越佳;但治疗过程中不强求绝对的解剖复位,要尽量达到关节面平整、桡骨短缩小于（2.89±0.87）mm、关节内骨折移位小于（1.72±0.56）mm、掌倾角丢失小于（8.78±3.63）°、尺偏角丢失小于（10.66±3.13）°的复位标准,腕关节功能恢复为优良,较传统评价标准的适用范围广。

Objective： To explore the relativity between functional recovery of wrist joint and restoration quality of colles＇ fracture. Methods： All 120 patients were intervened by operation or non-operation therapeutic regimen according to Frykman typing, and followed for 4 to 20 months, radial shortened distance, fracture displacement in the joint, palmar tilt and radial inclination were recorded with iconography before and after treating; anatomical scales were judged by Lidstrom scaling system; the function of wrist joint was graded by Garland and Werley wrist joint scaling system; to compare excellent rates of two kinds of evaluation standards. Results： After intervention, radial shortened distances of the patients were （1.62±0.34） mm, fracture displacement in the joints were （0.72±0.05） mm, palmar tilt drop was （0.69±3.45） °, when radial inclination drop was （6.32±2.87）°, the function of wrist joint restored the best, which was lower compared with traditional evaluation standard of radial shorten distance 5mm, fracture displacement in the joints 2mm, radial inclination drop 3° and palmar tilt drop 9°; Garland and Wefley evaluation showed that excellent rate was 92.5%, equivalent to 94.17% assessed by Lidstrom standard（P〉0.05）. Conclusion： The higher quality of manipulation reduction is for colles＇ fracture, the best wrist joint fimction recovers; abso lute anatomical reduction is not required during therapeutic course, reduction standard of smooth joint plane, radial shortened distances less than （2.89±0.87） mm, fracture displacement in the joints less than （1.72±0.56） mm, palmar tilt drop less than （8.78±3.63）° and radial inclination drop less than （10.66±3.13） o, with the best functional recovery of wrist joint, and the standard could be used more widely compared with traditional evaluation standard.