老年桡骨远端骨折保守治疗的疗效分析

Analysis of effect of conservative treatment on fracture of distal radius in the elderly patients

目的:研究桡骨远端骨折原始移位程度与骨折愈合后骨折对位质量的关系。方法:桡骨远端骨折患者41例,男5例,女36例;年龄50-82岁,平均67.8岁。按Lidstrom分型:Ⅰ型3例,Ⅱ型12例,Ⅲ型11例,Ⅳ型15例。按Frykman分型:Ⅰ型3例,Ⅱ型6例,Ⅲ型5例,Ⅳ型6例,Ⅴ型7型,Ⅵ型4例,Ⅶ型4例,Ⅷ型6例。粉碎性骨折20例。对愈合后的复位质量进行评估,并分别对L idstromⅠ-Ⅱ型和Ⅲ-Ⅳ型,FrykmanⅠ-Ⅳ型和Ⅴ-Ⅷ型,非粉碎性骨折和粉碎性骨折愈合后的复位质量进行了比较。结果:41例患者随访6个月,按Dienst复位质量评分,优3例,良21例,优良率为58.5%(24/41)。LidstromⅠ-Ⅱ型和Ⅲ-Ⅳ型愈合后复位质量优良率分别为86.7%(13/15)和42.3%(11/26)(P<0.01);FrykmanⅠ-Ⅳ型和Ⅴ-Ⅷ型愈合后复位质量优良率分别为65.0%(13/20)和52.4%(11/21)(P<0.05);非粉碎性骨折和粉碎性骨折愈合后复位质量优良率分别为81.0%(17/21)和35.0%(7/20)(P<0.01)。结论:原始移位大的、粉碎性的不稳定桡骨远端骨折,愈合后容易出现短缩和再移位,建议采用经皮穿针、外固定支架及开放复位内固定等方法恢复并维持桡骨远端的解剖对应关系。

Objective： To study the relationship between dislocated degree and healing outcome in fracture of distal radius. Methods： Forty-one patients with distal radius fracture,5 cases were male and 36 female with the average age of 67.8 years （ ranging from 50 to 82）. According to Lidstrom classification, type Ⅰ to Ⅳ each had 3,12,11,15 cases respectively ;According to Frykman typing,type Ⅰ to Ⅷ had 3,6,5,6,7,4,4,6 cases respectively. Twenty cases were comminuted fracture in the study. The healing condition of all the patients were evaluated and the effect of Lidstrom Ⅰ , Ⅱ and Lidstrom Ⅲ, Ⅳ, Frykman Ⅰ to Ⅳ and Frykman Ⅴ to Ⅷ, non-comminuted and comminuted fracture were compared. Results： All the patients were followed up for 6 months. According to Dienst scoring system,3 cases obtained excellent result and 21 good, the excellent and good rate was 58. 5% （ 24/41 ）. The excellent and good rate were 86. 7% （ 13/15 ）, 42. 3% （ 11/26 ）, 65.0% （ 13/20 ）, 52. 4% （ 11/21 ） ,81.0% （ 17/21 ） ,35.0% （7/20） respectively in Lidstrom Ⅰ , Ⅱ and Lidstrom Ⅲ, Ⅳ （ P 〈0. 01 ） ,Frykman Ⅰ to Ⅳ and Frykman V to Ⅷ （ P 〉 0. 05）, non-comminuted and comminuted fracture （ P 〈 0. 01 ）. Conclusion： Unstable fracture of distal radius with more initial displacement and comminuted fracture are prone to shortening and re-displacement after healing. Using percutaneous pins fixation, external fixation and internal fixation after open reduction for above fracture can regain and keep anatomic relations.