老年人桡骨远端骨折的手术治疗探讨

Exploration the value of operation in the distal radius fracture in the elderly

目的27例老年人桡骨远端脆性骨折患者，手术治疗后，对其治疗效果进行评估，分析和了解老年人桡骨远端骨折手术治疗的适应症，及手术治疗的优、缺点。方法对2002年1月-2008年3月间，60岁以上老年人桡骨远端骨折行手术治疗的27例患者进行随访、评估。年龄61—83岁，平均68．7岁，男：3例，女：24例。骨折AO分类A型、B型及C型各9例，手术方式为切开复位内固定术21例、闭合复位外固定架固定术6例，9例患者使用注射用硫酸钙作为骨缺损的填充，3例使用异体骨。随访时间3个月～77个月，平均25．9个月，用Dienst方法对治疗结果进行评分。结果除3例术后三个月骨折部分愈合外，其余骨折全部达到骨性愈合，评分结果为优5例、良12例、可3例、差7例，优良率为63％。主要并发症有手腕部疼痛、伸屈及旋转功能受限、握力下降，或残留腕部畸形。结论手术治疗是老年人桡骨远端移位骨折治疗的重要方法，但应严格掌握手术指征、合理选择术式及植骨材料，术后积极康复，才能达到理想的治疗效果。

Objective In order to analyze the indications and advantage or disadvantage of operative treatments for fragility fractures of distal radius. Methods 27 cases with more than 60 years old, were followed up. 27 aged patients with distal radius fracture acceptted operation from Jan. 2001 to Mar. 2008. The age distribution was from 61 to 83 years, and the mean age was 68. 7 years. There were 3 male and 24 female. According to AO criteria, the fractures were classified. Type A, B, C fracture were all 9 cases. 21 cases were treated with open reduction and internal fixation, and other 6 cases with closed reduction and external fixator. MIIG X3 and allograft were used to repair the bone defect in 12 cases. The follow-up period was 3 - 77 mon, and the average time was 25.9 mon. The final result was evaluated with Dienst assessment. Results Complete bone union occurred in 24 cases, and 3 cases partially united. The results was excellent in 5 cases, good in 12 cases, fair in 3 cases, poor in 7 cases. The main complication was pain over wrist, the partial disfunction on flexion, extension, rotation and grip strength. Conclusion The operation played an important role in the treatment of distal radius fragility fracture, especially in the elderly, but we should consider the operative indication and select correct fixation and graft material. Early rehabilitation schedule would be helpful for functional recovery.