Colles 骨折手法复位失败原因分析

Analysis of the failure causes about Colles fracture treated by manual reduction

目的：分析 Colles 骨折手法复位失败原因，针对性地提出解决策略。方法回顾性分析2010年11月—2012年11月甘肃省天水市第四人民医院203例 Colles 骨折患者临床资料。其中男81例、女122例，年龄15~83岁，均采用手法复位石膏托外固定治疗。根据骨折复位标准及 Dienst功能评定标准判定复位效果及临床预后，并分析患者性别、年龄、就诊时间、骨折类型、复位中不当因素与复位失败的关系。结果203例中首次复位失败24例，失败率11.8%。不同性别患者的复位失败率差异无统计学意义（P 〉0.05）；不同年龄、就诊时间、骨折类型、掌屈尺偏角度、复位过程中是否维持牵引患者的复位失败率差异均有统计学意义（P 值均〈0.05）。24例患者治疗后随访6~18个月，平均11.5个月。根据 Dienst 功能评定标准，疗效优8例、良5例、可4例、差7例，不满意率45.8%（11/24）。结论手法复位石膏外固定治疗 Colles 骨折有其优势所在，但也存在复位失败或导致腕关节功能受限的风险，其相关因素主要有患者年龄、就诊时间、骨折类型、复位中操作不当、不重视功能锻炼等，在临床实际工作中应引起足够的重视。

Objective To analyse the failure causes about Colles fracture gimmick reset, and propose new treatment strategy. Methods This was a retrospectively study and all the 203 patients were recruited from the Fourth People′s Hospital of Tianshui from November 2010 to November 2012, 81 males and 122 females were included, all of the patients were aged from 15 to 83. Based on fracture criteria and functional evaluation standards of Dienst determine the reduction effect and clinical prognosis, and meanwhile analyse the relations of patients gender, age, time of treatment, type of fracture and reset improper factor with the reset failed. Results Twenty-four cases failed in the first time of reduction, failure rate was 11. 8% （24 / 203）. There was no significant difference in gender（P 〉 0. 05）. However, the result was statistically different in patients′ age, time of treatment, type of fracture（all P values 〈 0. 05）. Twenty-four patients were followed up for 6 ~ 18 months after treatment, average 11. 5 months. According to the function evaluation standard of Dienst, the curative effects were rated as excellent in 8 cases, good in 5 cases, moderate in 4 cases, and poor in 7 cases, with the no satisfaction rate being 45. 8% （11 / 24）.Conclusions Although manual reduction plaster external fixation in the treatment of Colles fracture has its advantages, it also has the risk of failure or result in the function of wrist joint limited. The related factors are included patients′ age, gender, time of treatment, type of fracture, improper operation of physician, neglect on functional exercise and so on. These issues deserve adequate attention in clinical practice.