老年桡骨远端骨折治疗方法的探讨

Analysis on therapy of the distal fractures of radius in the elderly

目的对比分析手法复位石膏外固定和掌侧斜"T"形钢板内固定治疗老年桡骨远端骨折的疗效。方法 2010年10月—2011年6月分别采用手法复位加石膏托外固定及切开复位"T"形锁定钢板内固定治疗老年桡骨远端骨折146例,采用Gartland等腕关节评分进行功能评定,比较两种不同治疗方法的疗效。结果所有患者均获得随访,随访时间6～15个月,平均11.3个月。X线显示骨折全部愈合。Gartland腕关节评分手法复位石膏外固定组优良率为72.2%,掌侧斜"T"形钢板内固定组优良率为87.8%,差异有统计学意义(P<0.01)。结论尽管钢板内固定的优良率较高,但除少数经关节面且有明显关节面移位,非手术治疗失败的老年桡骨远端骨折可采用手术治疗外,大多数老年桡骨远端骨折经手法复位石膏外固定非手术治疗即可取得较为满意的临床效果,手术的选择应慎重,应尊重患者的要求。

Objective To compare the outcomes of operation and manual reduction,plaster immobilization and palmar T-plate internal fixation on in treatment of senile comminuted distal radial fractures. Methods One hundred and forty six senile patients with comminuted distal radial fracture were treated with manual reduction,plaster immobilization and palmar T-plate internal fixation from October 2010 to June 2011.Functional evaluation was performed according to the Gartland wrist score,the outcomes of two methods were compared. Results All patients were followed-up,the follow-up period was 6-15 months,and average period was 11.3 months.X-ray showed the fractures were all cured.According to Gartland wrist score,the excellent rate was 87.8% for palmar T-plate internal fixation,and 72.2% for manual reduction and plaster immobilization.The difference showed statistical significance（P0.01）. Conclusion Although the excellent rate of palmar T-plate internal fixation was higher,the large majority of fractures of the distal radius can be treated with non-operative measures in the form of manual reduction and plaster immobilization,particularly in older patients with limited functional demands.Surgical intervention is generally reserved for displaced,comminuted fractures in which closed reduction fails to achieve or maintain acceptable fracture reduction.The treatment method of the aged distal radius fracture should be objectively choosed,respect the patient＇s expectation and demands as far as possible.