桡骨远端骨折的个体化治疗及其临床意义

Individual treatment and its clinical significance in the management of distal radial fractures

目的：观察不同治疗方法对不同类型桡骨远端骨折的临床治疗效果,探讨个体化治疗桡骨远端骨折的临床意义.方法：收集我院在1999年6月-2003年1月收治的198例桡骨远端骨折患者的临床资料,按Cooney桡骨远端骨折的国际分类系统分型,分为Ⅰ～Ⅵ型,各型骨折随机分为保守治疗组和手术治疗组,随访观察两组各型骨折的临床疗效.193例分别获得4～38个月随访（平均9个月）.采用改良Gartland and Werley（GW）评分系统对腕部进行功能评估.根据主、客观标准分为不同的功能等级：0～2分为优,3～8分为良,9～14分为中,≥15分为差.结果：手术治疗组优37例,良39例,中21例,差2例.保守治疗组优29例,良44例,中13例,差8例.Ⅰ、Ⅲ型骨折手术治疗组要比保守治疗组的GW评分要高,但二者差异无统计学意义（P＞0.05）;Ⅱ、Ⅵ型骨折手术治疗组的GW评分要明显低于保守治疗组,二者差异具有统计学意义（P＜0.05）.结论：桡骨远端骨折的治疗要根据不同骨折类型采用不同治疗方法,才能获得良好的临床疗效.个体化治疗桡骨远端骨折具有重要的临床意义.

Objective： To evaluate the clinical results of distal radial fractures with conservative methods and open techniques respectively, and study the clinical values of individual management to the distal radial fractures. Methods：From June 1999 to January 2003,198 patients＇ clinical data with distal radial fractures were analyzed. The fractures were classified into six types according to the Cooney international classification. All patients were randomly treated with conservative methods and open techniques. They were followed up form 4 to 38 months with an average of 9 months. The functional evaluation depended on the modified Gartland and Werley＇ s（GW） scoring system,0-2 score was excellent,3 -8 good,9 -14 fair,more than 15 poor. Results： In the surgical group, 37 cases obtained excellent, 39 good, 21 fair, 2 poor, In the conservative group, 29 cases obtained excellent,44 good, 13 fair and 8 poor. The scores of Type Ⅰ and Ⅲ fracture in the surgical group were higher than that of the conservative group, but there were no significant difference （ P 〉 0. 05 ）. The scores of type Ⅱ and Ⅳ fracture in the surgical group were lower than that of the conservative group, moreover, there were significant difference （P 〈 0. 05）. Conclusion：Different types of the distal radial fracture should be treated with different methods ,and individual management have important clinical value in the treatment of the distal radial fractures.