老年桡骨远端粉碎性骨折治疗方法的对比研究

Efficacy analysis of different treatment on distal radius comminuted fracture in elderly patients

目的:探讨老年桡骨远端粉碎性骨折治疗方法的选择。方法:将126例老年桡骨远端粉碎性骨折采取手法复位夹板外固定、T型解剖接骨板内固定、半环式外固定支架固定三种方法治疗。结果:126例随访3个月至2年,按Dienst功能评定标准,手法复位夹板固定治疗92例,优良率67.4%,患者满意度93.4%;T型解剖接骨板内固定治疗18例,优良率77.8%,患者满意度83.3%;半环式外固定支架固定治疗16例,优良率87.5%,患者满意度87.5%。经统计学处理,患者对3种治疗方法均满意,但在疗效上,半环式外固定支架组疗效优于手法复位夹板外固定组,差异有统计学意义(P<0.01),T型解剖接骨板内固定组与其他两组比较差异无统计学意义(P>0.05)。T型解剖接骨板内固定组平均医疗费为5326元,手法复位夹板外固定组平均为864.32元。结论:治疗老年桡骨远端粉碎骨折3种方法治疗各有优势,只有根据患者的骨折类型、骨质疏松程度,手术耐受程度,老年人对腕关节功能恢复的期望值及治疗费用合理选择治疗方式,切忌使手术治疗扩大化。

Objective：To study the choice for treatment of distal radius comminuted fracture in elderly patients.Method：126 elderly patients with distal radius comminuted were treated with manipulative reduction and splint external fixation,the ＂T＂ type anatomical plate fixation,semi-ring external fixation.Result：126 cases were followed up for 3 months to 2 years.According to the Dienst wrist score,the excellent rate was 67.4% and the satisfactory rate was 93.4% in splint group of 92 cases.The excellent rate was 77.8% and the satisfactory rate was 83.3% in ＂T＂-type plate group of 18 cases.The excellent rate was 87.5% and the satisfactory rate was 87.5% in half ring external fixation group of 16 cases.All the patients were satisfied with the three methods.But in terms of efficacy,the half-ring external fixation group was more effective than the splint group statistically.The ＂T＂ type plate fixation group has no significant difference with the other two groups（P〉0.05）.The average medical expenses was 5326 yuan in ＂T＂ type plate fixation group,The average medical expenses was 864.32 yuan in splint group.Conclusion：All the three ways to the treatment of senile distal radius fractures has their own advantages.We should choose a treatment reasonably according to the types of fractures,the degree of osteoporosis,surgical tolerance,recovery expectations and the cost of treatment.