选择性非手术治疗不稳定性桡骨远端骨折的临床研究

Clinical Investigation Effects of Selective and Non-operative Treatment on Unstable Fractures of Distal End of the Radius

目的探讨选择性非手术治疗不稳定性桡骨远端骨折临床效果。方法采用手法复位背侧单夹板掌屈10～20°位固定治疗背侧倾斜、塌陷且向掌侧成角的桡骨远端新鲜闭合性骨折20例,并在C型臂X线机监视下对整复后腕关节固定位置进行观测。结果本组20例在腕关节中立位固定时有移位的可能,占45%(9/20);在掌屈位固定均未发生骨折端移位,占100%(20/20);在背伸10°时,大部分发生移位,占75%(15/20);当背伸位大于10°时,骨折端随着背伸位的角度增加移位也逐渐增大,甚至完全移位。本组20例骨折全部一期愈合。结论对于背侧倾斜、塌陷且向掌侧成角的桡骨远端新鲜闭合性关节外不稳定性骨折,采用单夹板掌屈10～20°位固定可取得满意的临床效果。

Objective To investigate the clinical effects of selective and non-operative treatment on unstable fractures of the distal end of the radius.Methods During the period of 05/2007 to 06/2009, manual reduction, dorsal mono-splint fixation in palmar flexion 10°-20° was adopted as the treatment of choice in 20 cases of a closed fracture of the distal end of radius, features of which were dorsal obliquity, collapse, and angulations to palmar side. Meanwhile, under the surveillance of C-arm image intensified fluoroscopy, the observation of carpal joints＇ positions after reduction was taken.Results Among 20 cases under observation, 45 percent （9 cases） suffered fracture displacement with fixating wrist neutral positions. One hundred percent of cases （20 cases） never went through fracture displacement of fracture ends during fixating palmar flexion, no matter what the degree of tlexion was. Seventy-five percent of cases （15 cases） experienced fracture displacements appearing on fracture ends when the degree of wrist dorsal angulafions was 10. Fracture displacement on fracture ends became more severe, even displaying complete displacement along with an increased degree of wrist dorsal angulations when the degree of wrist dorsal angulations was more than 10. Among the 20 cases treated by mono-splint fixation in palmar flexion 10°- 20°, all the patients were followed up for 8-27 months with an average of 13 months.Conclusions As one of the treatments for closed fracture of the distal end of the radius typically exhibiting features such as dorsal obliquity, collapse and angulations to the palmar side, the adoption of mono-splint fixation in palmar flexion 10°-20° is a simple operation, shows reliability on fixation, and during the recovery period, the wrists can be moved within a specified range. This treatment has changed traditional, non-operative treatment methods requiring a lengthy fixation as well as provided a new method of non-operative treatment of a fracture of the distal end of the radius.