Coony Ⅱ型桡骨远端骨折的手术与保守治疗

Coony type Ⅱ distal radius fracture: surgery versus conservative treatment

[目的]比较CoonyⅡ型桡骨远端骨折手术与保守治疗的疗效,为临床合理诊疗提供依据。[方法]对2013年3月~2015年4月本院收治的CoonyⅡ型桡骨远端骨折患者106例进行临床对照研究。按照治疗方式分为2组,分别采用切开复位“T”型解剖钢板内固定（手术组）和手法复位联合塑形小夹板外固定（保守组）治疗方式,比较2组治疗后碗部疼痛情况、腕关节功能及患者的生活质量。[结果]106例患者均完成1年的随访。手术组全部患者得到解剖复位,有1例术后出现Sudeck骨萎缩;而保守组l0例畸形愈合,其中3例患者因夹板松脱等原因未能及时来院复查,致骨折畸形严重,功能较差。在治疗后6周,3、6个月随访时间点,手术组Gartland-Werley（GW）评分和PRWE评分均优于保守组,比较结果差异有统计学意义（P〈0.05）,但随着随访时间延长,差异逐渐减小,在1年随访时,两种治疗方法治疗效果比较差异无统计学意义（P〉0.05）。[结论]手术治疗与保守治疗CoonyⅡ型桡骨远端骨折均可取得较好疗效,与保守治疗相比,手术治疗可实现解剖复位和坚强固定,避免骨折再移位,其早期疗效优势明显,但由于保守治疗方法简单、费用低廉、患者痛苦较小,所以实际临床工作中需要综合考虑患者的功能需求、年龄以及经济情况等因素,制定个性化治疗策略。

[ Objective] To investigate the effect of surgery versus conservative treatment for Coony type II distal radius frac- ture, so as to provide a basis for reasonable clinical diagnosis and treatment. [ Method] A controlled clinical trial was performed in 106 patients with Coon-~T type II distal radius fracture who were admitted to out hospital from March 2013 to April 2015. Ac- cording to treatment modality, the patients were divided into surgical treatment group （open reduction and internal fixation with T -shaped anatomic plate） and conservative treatment group （manual reduction combined with external fixation with shapeable small splint）. The pain in the wrist, wrist joint function, and patients＂ quality of life after treatment were compared between the two groups. [ Result] All the 106 patients completed the 1 - year follow - up. All the patients in the surgical treatment group a- chieved anatomical reduction,among whom 1 patient experienced Sudeck bone atrophy after surgery. In the conservative treat- ment group, 10 patients experienced malunion,including 3 patients who did not undergo reexamination in time due to splint loos- ening, which further caused serious fracture deformity and poor function. At 6 weeks,3 months, and 6 months after treatment, the surgical treatment group showed significantly better Gartland -Werley score and Patient -rated Wrist Evaluation score than the conservative treatment group （ P 〈 0.05 ）, but the differences were gradually reduced over the time of follow - up. At the 1 - year follow- up,the treatment outcome showed no significant difference between the two groups （P 〉0.05）. [ Conclusion] In the treatment of Coony type Ⅱ distal radius fracture, both surgical treatment and conservative treatment achieve good effects. Compared with conservative treatment, surgical treatment can realize anatomical reduction and rigid fixation and avoid fracture redis- placement and shows a significantly better early therapeutic effect. However, since conservative treatment is simple, cheap, and less painful, factors such as the patient＇s functional requirements, age and economic conditions need to be considered in clinical practice so as to develop individualized treatment strategies.