对保守治疗桡骨远端骨折稳定性的评价

Evaluation of stability of distal radius fracture after conservative treatment

目的对保守治疗桡骨远端骨折稳定性的效果进行评价。方法选取桡骨远端骨折患者103例为研究对象，均在我院急诊接受闭合整复石膏外固定治疗，分别在1、2、4周时复查。患者在整复前后及每次复查均接受标准的正侧位X线检查。采用Cooney分型对这些骨折分类，并在每张X线上精确测量移位值，掌倾角，尺偏角，桡骨短缩，并标记桡腕关节面的分离和塌陷。结合Lidstrom评分系统，将拆除石膏后的影像学效果分为可接受和不可接受两组。最后应用Pearson Chi-Square test，likelihood test，Kendall correlation analysis对不同Cooney分型的影像学效果进行评价。结果103例骨折有69．9％经保守治疗后效果可接受。其中Cooney分型1型，2型，3型的桡骨远端骨折经保守治疗效果较满意。达到可以接受效果的比例分别为：90％，88．5％，88．9％。4型骨折中只有28．1％经保守治疗后达到可以接受的标准。不同Cooney分型经保守治疗后的效果之间有显著性差异。2型骨折中有19例（36．8％）在保守治疗后残留移位，其中84．2％的骨折在石膏固定1周内移位。4型骨折中21例（65．6％）在保守治疗后残留有关节面的移位，同样有85．7％的骨折在石膏固定1周内移位。结论大部分桡骨远端骨折经保守治疗可以取得良好的结果。Cooney分型中的1型、2型、3型桡骨远端骨折手法复位后较稳定，所以治疗应首选手法复位，石膏外固定。但4型极不稳定，保守治疗效果不满意的比例较高，最好采用手术治疗以取得更好的治疗效果。而且应该重视这类骨折在手法复位后1～2周内的复查，以便及时采取有效措施。

Objectives To evaluate the effect of conservative treatment on stability of different types of distal radius fracture so as to help select the optimal treatment of different distal radius fracture and verify the exact time when the patient need careful. Methods During the period of one year 103 consecutive patients of distal radius fracture were treated by closed reduction and below-elbow cast immobilization and standard PA in the emergency room and were followed up 1, 2, and 4 weeks after the initial visit until the casts were removed. Lateral radiographic examination was conducted before and after reduction and during the reexamination. All the images were saved in a working server in hospital. The patients were classified according to the Cooney classification system, then the displacement, palmar flit, radial inclination and radial shortening in every film were measured accurately and involvement of radiocarpal joint surface was noted. Combined with the assessment by the Lindstrom grading system, the radiographic results were divided into 2 groups： accepted and unaccepted. Finally, Pearson Chi-square test, likelihood ratio test, and Kendall correlation analysis were used to testify the radiographic results of different Cooney types. ResultsFractures of Cooney type 1, 2 and 3 achieved good results after non-operative treatment with the rates of accepted results of 90%, 88.5%, and 88.9% respectively. Only 28.1% of the type 4 fractures reached the accepted criteria. The general rate of accepted results among the 103 fracture patients was 69.9%. The general rate of accepted results of the 103 patients was 69.9%. The rates of accepted results of the Cooney type 1, 2, 3, and 4 fractures were 90. 0%, 88.5%, 88.9%, and 28. 1% respectively. The radiographic result was significantly correlated with the Cooney classification with a large Kendall coefficient. Displacement after closed reduction was found in 36.5% of the type 2 fractures and 65.6% of the type 4 fractures and a large majority of them displayed instability within a week after the closed reduction and cast immobilization. Conclusion A large majority of the distal radius fractures can achieve good results after treatment by closed reduction and cast immobilization, especially those of type 1, 2, and 3, for which conservative treatment should be the first choice. However, type 4 fracture is extremely unstable and a large percentage of it fails to get satisfactory result by non-operative treatment, so operative treatment is better for it. Beexam/nation 1 - 2 weeks after the manipulation should be emphasized so as to adopt effective treatment in time.