桡骨远端骨折手术治疗后主观与客观评价方法间关系的研究

Study of Association between the Subjective and Objective Evaluation Methods after Operative Fixation of DistalRadius Fracture

目的探讨桡骨远端骨折后以医生客观检查为主的评价方法与以患者主观感受为主的评价方法之间的关系,并分析腕关节的功能主要受哪些因素的影响。方法回顾性分析桡骨远端骨折术后接受手术治疗且随访超过1年的患者205例,在术后2、4、6周及3、6、12个月,医生分别测量患者腕关节最大伸屈、旋前旋后、桡偏尺偏角度及握力,患者填写肩、前臂、手功能(disabilities of the arm,should,and hand,DASH)调查问卷和疼痛评分。通过多元线性回归模型评估两种评价方法间的关系。结果经手术治疗后,患者腕关节在各个维度的活动范围、握力不断提高,术后1年伸屈角能达到(113.7±6.9)°,旋后能达到(81.2±3.8)°,握力能恢复至对侧的81.6%;DASH评分及疼痛评分不断降低,术后1年DASH和疼痛评分分别为(17.6±2.9)分,(16.1±2.5)分。经回归分析可知,疼痛评分、握力和旋后角度三个变量与DASH评分存在相关性,能解释DASH评分变异的61%,经模型重建后的相关系数分别为4.03,-0.19,-0.427。而其他因素与DASH评分的关系不明显。旋后功能对腕关节功能的发挥起着十分重要的作用。结论疼痛、握力和旋后是影响患者术后腕关节功能的重要因素,与患者的自我体验密切相关。

Objective To explore the relationship between the surgeons exmnination-based objective measure method and the patient-based subjective feeling evaluation methodfor distal radius fracture. Methods 205 patients who received operative ~fixation of distal radius fracture and were up for more than 1 year were retrospectively investigated. The surgeons measure wrist range of motion including flexion-extension arc, supination-pronation, radial-ulnar deviation, and grip strength;while the patient completed the DASH questionnaire and visual analog scale （VAS） to grade the current level of function and pain at 2,4,6 weeks and 3,6,12 months after the operation. A multivariate linear regression model was constructed to evaluate the association of range of motion,girp strength, and VAS score with the DASH score. Results The range of motion and grip strength improved continually after the operation, the flexion-entension arc was （ 113.7± 6.9）° and supination angle was （ 81.2 ± 3.8）°, grip strength recovered to 81.6% of the contralateral hand. While the DASH and VAS score reduced gradually and to （ 17.6 ± 2.9）, （16.1 ± 2.5） respectively 1 year after. Regression model showed VAS score, grip strength and supination were the sig- nificant related to the DASH score, and could count for 61% of the variability of DASH. The regression coefficient was 4.03, -0.19, -0.427 respctively in revised model. The other factors had no significant correlation to DASH score. The supination range had important role in wrist function. Conclusion Pain, strength and supination were major factors effects function of wrist wter surgery and had significant relationship with the selfexperience of distal radius fracture patients.