折顶法结合横向挤压法治疗桡骨远端粉碎性骨折

Clinical Observation of Top-fold Manipulation Combined with Transverse Squeezing Manipulation for Treatment of Comminuted Distal Radius Fractures

【目的】评价折顶法结合横向挤压法治疗桡骨远端粉碎性骨折的临床疗效。【方法】应用折顶法结合横向挤压法治疗桡骨远端粉碎性骨折84例。随访内容包括X线表现和腕关节的疼痛程度、功能状况、活动范围、握力等,并采用Cooney等修订的Green-O’Brien腕关节评分标准进行腕关节评分。【结果】随访时间3～18个月,平均9个月;4例骨折再次移位（桡侧移位2例,背侧移位1例,掌侧移位1例）,再次复位3例,拒绝再次复位1例;中后期发现桡骨短缩8例;所有患者均骨性愈合;按Green-O’Brien腕关节评分标准评定,本组疼痛评分平均为（22.93±0.80）分,功能障碍评分平均为（22.80±1.50）分,活动范围评分平均为（19.42±0.60）分,握力评分平均为（19.60±0.10）分,总分平均为（84.75±0.39）分。其中优34例,良43例,可5例,差2例。【结论】采用折顶法结合横向挤压法治疗桡骨远端粉碎性骨折可取得满意的临床疗效。

Objective To investigate the therapeutic effect of top-fold manipulation combined with transverse squeezing manipulation for comminuted distal radius fractures. Methods Eighty-four patients with comminuted distal radius fractures were treated by top-fold manipulation combined with transverse squeezing manipulation. After treatment, X-ray photographic results, and pain degrees, functional status, movement range and grip strength of the affected wrist joint were followed up. The modified Green-O＇Brien wrist joint scoring criteria were adopted for the scoring of wrist joint. Results The follow-up lasted for 3-18 months, averaging 9 months. The results of follow-up showed that re-displacement occurred in 4 patients, and the re-displacement was shown as radial displacement in 2 cases, dorsal displacement in one case, and palmar displacement in one case. Three cases of 4 re-displacement patients got re-positioning, and the left one refused to have re-positioning. At the middle and late stages, 8 patients had radius crispation. All of the patients got bone union. The results of modified Green-O＇Brien wrist joint scoring showed that the mean pain scores were 22.93 ± 0.80, functional disorder scores were 22.80±1.50, movement range scores were 19.42 ± 0.60, grip strength scores were 19.60 ± 0.10, and the total scores were 84.75 ± 0.39. The results of therapeutic effect grading showed that 34 cases were excellent, 43 were good, 5 were fair and 2 were poor. Conclusion Top-fold manipulation combined with transverse squeezing manipulation shows satisfactory therapeutic effect for comminuted distal radius fractures.