影像学测量对保守治疗桡骨远端骨折再移位的预测价值

Predictive value of radiological parameter for re displacement of conservative treatment of distal radius fracture

目的 ：测量桡骨远端骨折保守治疗后腕关节影像学测量数据,分析其对最终的再移位有无预测作用。方法：2013年1月至2014年6月对212例成人桡骨远端骨折经保守治疗患者回顾性研究,筛选后107例患者因影像学资料不全被排除,剩余105例患者均具备完整影像学资料,其中男56例,女49例;年龄22-80岁,平均51岁。参照AO分型：A2、C1型63例,A3、C2、C3型42例。105例接受手法闭合复位前臂石膏托固定腕关节4-6周。随访3-6个月复查X线片（平均随访4.5个月）骨折全部愈合。复位前后和骨折愈合后分别拍摄腕关节标准正侧位片,对其背侧成角、尺偏角进行准确测量。测量所得数据用线性回归函数进行分析,了解影像学测量数据对再移位有无预测作用。结果：在105例患者中,复位后的尺偏角和骨愈合后的尺偏角,复位后的背侧成角和骨愈合后的背侧成角之间都具有预测价值的相关性（r=0.82,r=0.85）,复位后的背侧成角和尺偏角对于骨折愈合后的再移位具有预测价值。结论：再移位的背侧成角和尺偏角可以通过回归函数方程被预测,通过计算如果骨愈合时的背侧成角和尺偏角再移位可能性大,未达到复位标准时,患者需再次复位或改行手术治疗。

Objective：To analyze the radiological parameters of the conservatively in treating distal radius fracture and investigate whether the final re displacement can be predicted after primary reduction. Methods：From January 2013 to June2014,212 patients with distal radial fracture conservatively were treated in our hospital,107 patients of them were excluded because of their incomplete radiological parameters;the remaining 105 patients were available for radiological were assessed after injury,there were 56 male patients and 49 female patients in this study,the average age of the patients was 51 years old（ranged from 22 to 80 years）. According to AO classification,there were 47 cases of type A2 and C1,and 58 cases of type A3,C2,C3. All patients were treated by closed reduction and below elbow cast immobilization for 4 to 6 weeks. All patients were followed up for 3 to 6 months（means 4.5 months） by X ray,all fractures were healed. Standard AP and lateral radiographic examination was conducted before reduction and after reduction and bony consolidation,the dorsal angulation and the radial angle were measured at each time point. The linear regression was used for the analysis to find out whether the final re displacement can be predicted after primary reduction. Results：Among 105 patients,the significant correlations were found for the dorsal angulation between the reduction time and the end time（r=0.82） and for the radial angulation between the reduction time and end time（r=0.85）. Conclusion：The dorsal angulation and the radial angulation after complete healing can be predicted from linear the regression functions. Due to the possibility of predicting the end result,whether the fracture should receive further conservative treatment or surgical treatment can be decided immediately.