小夹板结合3D打印支具外固定治疗Colles骨折

Small splint external fixation combined with 3D printing brace for the treatment of Colles fractures

目的:探讨手法复位小夹板配合3D打印腕关节支具外固定治疗Colles骨折的近期临床疗效,以及支具的使用优势。方法:选取2017年2月至12月在中山市中医院就诊的Colles骨折患者,符合纳入标准的共60例。所有患者分为两组,即对照组和试验组。对照组30例,男13例,女17例;年龄16~66(49.46±12.63)岁;损伤至就诊时间3~18 (6.86±3.15) h。试验组30例,男12例,女18例;年龄14~68(46.73±14.40)岁;损伤至就诊时间3~19 (7.06±3.45) h。试验组及对照组患者均由同一医师手法整复骨折,X线片显示复位满意后予以小夹板外固定。待骨折整复后1周起,试验组拆除小夹板,更换3D打印支具维持固定至骨折愈合;对照组维持小夹板固定直至骨折愈合后拆除。两组患者分别在整复前后、复位后4周摄腕关节X线片,观察掌倾角、尺偏角、桡骨高度并比较;同时记录复位前后,复位1、2周后两组患者VAS评分、肿胀程度评分;复位6~8周解除外固定后比较两组腕关节Cooney及患者腕关节自我评价评分(patient rated wrist evaluation,PRWE)评分。结果:复位2周VAS评分试验组2.40±0.49,对照组2.43±0.50,两组比较差异无统计学意义(P=0.364);肿胀程度评分试验组0.50±0.50,对照组0.53±0.50,两组比较差异无统计学意义(P=0.746)。复位6~8周后试验组Cooney及PRWE评分优于对照组(P<0.05),掌倾角、尺偏角、桡骨短缩等解剖学特征方面试验组优于对照组(P<0.05)。结论:3D打印支具轻巧透气、舒适美观、方便敷药,结合小夹板分时段应用于Colles骨折临床疗效确切,丰富了外固定治疗的方法。

Objective:To explore the short term clinical efficacy of manipulation reduction combined with small splint and 3D printing wrist brace external fixation of wrist brace for Colles fracture and the advantages of using the brace.Methods:A total of 60 patients with Colles fractures who were treated in Zhongshan Hospital of Traditional Chinese Medicine from February to December 2017 were selected.Patients were randomly divided into 2 groups according to the order of treatment,with 30 patients in the control group,including 13 males and 17 females,aged from 16 to 66 years,with a mean of(49.46±12.63)years;the time from injury to consultation ranged from 3 to 18 h,averaged(6.86±3.15)h.In the experimental group,there were 30 cases,12 males and 18 females,ranging in age from 14 to 68 years old,with a mean of(46.73±14.40)years old;the time from injury to consultation ranged from 3 to 19 h,averaged(7.06±3.45)h.All the patients in the experimental group and the control group were treated with the same doctor’s manipulation to reduce the fracture.The small splints were applied for external fixation after the satisfactory reduction shown in the X ray.After 1 week of fracture treatment,the small splints were removed from the patients in the experimental group and the 3D printing braces were replaced to maintain fixation until the fracture healed.In the control group,small splints were maintained until the fracture healed.Wrist joint X ray films were taken before and after reduction and 4 weeks after reduction to observe the palmar inclination angle,ulnar deviation angle,radius height and compare;VAS score and swelling degree score were recorded before and after reduction for 1 and 2 weeks;Cooney and PRWE score of wrist joint were compared after 6 to 8 weeks of reduction.Results:The VAS score of 2 weeks after reduction was 2.40±0.49 in the experimental group and 2.43±0.50 in the control group.There was no statistical difference in the VAS score between the two groups before and after reduction(P=0.364).The swelling degree of 2 weeks after reduction was 0.50±0.50 in the experimental group and 0.53±0.50 in the control group.There was no statistical difference in the swelling degree between the two groups before and after reduction(P=0.746).The Cooney and PRWE scores of the experimental group were better than those of the control group 6 to 8 weeks after reduction(P<0.05),and the anatomical characteristics of palmar inclination,ulnar deviation and radial shortening of the experimental group were better than those of the control group(P<0.05).Conclusion:3D printing braces are light and breathable,comfortable and beautiful,and convenient for dressing.The combination of small splint sequentially applied to Colles fracture has a definite clinical effect,which enriches the means of external fixation treatment.It is believed that with the deepening of clinical research,the design and materials of 3D printing braces as well as their application in future medical treatment will be further developed.