手法整复夹板外固定治疗老年C型Colles骨折90例

Therapeutic Effects of Closed Manipulative Reduction and Splint External Fixation in the Treatment of Elderly Colles Fractures of Type C

目的：评价闭合手法整复夹板外固定治疗老年C型Colles骨折的临床疗效。方法：对2006年8月-2013年6月收治的90例老年C型Colles骨折患者的临床资料进行回顾性分析，其中女58例、男32侧；年龄52-85岁，平均65．8岁；按AO分类，C1型33例、C2型37例、C3型20例；所有病例采用闭合手法整复夹板外固定治疗。治疗后第3天、1周、2周、4周、6周复查X线片，第6周拆除夹板，夹板拆除6个月后按照Gartland-Werley腕关节功能评分法对C型中不同亚型的临床疗效进行总结分析。结果：所有患者均获随访，平均随访时间为6个月（4～8个月），所有患者均获得骨性愈合，愈合时间为8～14周，平均10．5周。均未发生压疮、正中神经受损及骨筋膜间室综合征。按照Gartland—Werley腕关节功能评分，Cl型总分（4．1±2．1）分，C2型总分（6．8±1．6）分，C3型总分（14．5±2．7）分。疗效优18例、良45例、可23例、差4例。总优良率为70．0％，其中C1型的优良率为84．8％、C2型为78．4％、C3型为30．0％．结论：闭合手法整复夹板外固定治疗老年C1、C2型伸直型桡骨远端骨折能获得满意的疗效，但C3型欠佳。

Objective： To evaluate clinical effects of closed manipulative reduction combined with splint external fixation in the treatment of elderly Colles fractures of Type C. Methods： From August 2006 to June 2013, 90 patients with elderly Col les fractures of Type C were treated with closed manipulative reduction combined with splint external fixation.. There were 32 males and 58 females, ranging in ages from 52 to 85. According to AO classification, there were 33 cases of C1,37 cases of C2,20 cases of C3. All the patients were treated with closed manipulative reduction combined with splint external fixation and followed up at 3r day, 1st week,2nd week,4th week, 6 th week after treatment. The splint was removed at 6th week. The clinical effects of different subtypes in type C were summarized according to wrist function scores with Gartland-Werley. Results.. All the patients were followed up, and the duration ranged from 4 to 8 months（averaged 6 months）. All the patients had bony union and the union time ranged from 8 to 14 weeks （averaged 10.5 weeks）. No complications, such as pressure sores, nerve medianus damage and Osteofascial compartment syndrome, occurred in all patients. According to wrist function scores with Gartland-Werley criterion, Subtype Clscored 4.1 ± 2.1, C2 6.8 ± 1.6, C314.5 ± 2.7. Excellent results were obtained in 18 patients（including Cl12 cases, C26）, good in 45 （including Cl16 cases, C223, C36） ）, fair in 23 （including C15cases,C27 ,C311） ,and bad in 4. （including C21 case, ,C33））. The total excellent and good rate were 70.0%. The excellent and good rate in C1 was 84.6%, C2 78.4%, C3 30.0%. Conclusion.. Closed manipulative reduction combined with splint external fixation in the treatment of elderly Colles fractures of Type C provides approving effect for C1 and C2, but poor for C3.