老年人桡骨远端骨折的手术治疗

Operative treatment of 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,男性:3例,女性: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月～77月,平均25.9月,用Dienst方法对治疗结果进行评分。结果除3例术后3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 analysze the indications and advantage or disadvantage of operative treatments for fragility fractures of distal radius, 27 cases, more than 60＇s years old, were followed up. Methods 27 patients were operated from Jan. 2001 to Mar. 2008. The age distribution was 61 to 83 years, and the mean age was 68.7 years. There were 3 male and 24 female. The fractures were classified according to AO criteria,9 cases were each in type A,B,C. 21 cases were treated with open reduction and internal fixation, other 6 cases with closed reduction and external fixator. MIIG X3 and allografi were used to repair the bone defect in 12 cases. The follow-up period was 3 mon-77 mon, the average time was 25.9mon. The final result was evaluated with Dicnst assessment. Results Complete bone union occurred in 24 cases. Other 3 partially united. The treatment assessment was excellent 5 cases, good 12 cases, fair 3 cases, poor 7 cases. The main complication was pain over wrist, the partial disfunction on flexion,extension,rotation and strength. Conclusions The operation played a important role in the treatment of distal radius fragility fracture in old patients, but we should closely notice the operative indication; correct fixation and graft material. Early rehabilitation schedule would be helpful for functional recover.