闭合复位与切开复位治疗桡骨远端骨折的效果比较

Comparison of the effects of closed reduction and open reduction in the treatment of distal radius frac-tures

目的：探讨闭合复位与切开复位手术治疗桡骨远端骨折的临床效果。方法将80例桡骨远端骨折患者作为研究对象，应用计算机随机分为观察组和对照组，对照组40例采用切开复位锁定钢板治疗，观察组40例采用闭合复位外固定架治疗。观察并记录两组患者的手术时间、术中出血量、骨折愈合时间以及下尺桡关节稳定性、术后6个月的腕关节活动度、并发症发生情况和治疗后患者的满意度，并对其结果进行比较分析。结果观察组患者的平均手术时间以及术中出血量均少于对照组[（42．3±1．4）、（63．4±2．1） min，（21．4±11．2）、（63．3±12．4） ml]，差异均有统计学意义（t值分别为52．874、15．859，P均＜0．05），而两组患者的骨折平均愈合时间差异无统计学意义（ P＞0．05）。两组患者术后6个月的掌曲、背伸、桡偏、尺偏、旋前、旋后等腕关节活动度比较差异均有统计学意义（ P均＜0．05）。观察组Gartland-Werleyde疗效判定总优良率、下尺桡关节稳定率与对照组比较差异均无统计学意义（ P 均＞0．05）。观察组术后并发症总发生率为7．5％（3／40），总满意度为92．5％（37／40），明显高于对照组[27．5％（11／40），75．0％（30／40）]，差异均有统计学意义（χ2值分别为5．54、4．50，P均＜0．05）。结论闭合复位与切开复位对老年桡骨远端骨折Gartland-Werleyde疗效和下尺桡关节稳定性均有一定的效果，＆amp;nbsp；但是闭合复位可减少手术时间和术中出血量，有利于降低术后并发症的发生率，提高患者的满意度。

Objective To compare the superiority-inferiority of wrist function recovery of closed reduc-tion and open reduction in the treatment of distal radius fracture. Methods Eighty cases of distal radius frac-tures patients were randomly divided into the study group and the control group. The control group were treated with open reduction and locking plate for treatment,the study group were treated with closed reduction and exter-nal fixation for treatment. The two groups were observed and recorded on operative time,blood loss,fracture heal-ing time, and Gartland-Werleyde determine the efficacy, stability of the distal radioulnar joint, wrist after 6 months of activity,conditions and treatment of complications after patient satisfaction,and compared the results of its analysis. Results The mean operative time and blood loss of the study group patients were significantly less than the control group（（42. 3±1. 4） min vs. （63. 4±2. 1） min,（21. 4±11. 2） ml vs. （63. 3±12. 4） ml）,the difference was statistically significant（t=52. 874,15. 859,P〈0. 05）,while there was no statistically significant difference on the mean healing time between the two groups（ P〉0. 05） . There were no significant differences in terms of the degree of activity of the wrist joint,such as palm,back,radial deviation,ulnar deviation, rotation, and rotation of two groups 6 months after treatment（ P〈0. 05） . There was no significant difference in terms of the total excellent rate of Gartland-Werleyde effect and the stability of the lower ulnar radial joint between the two groups（P〉0. 05）. The incidence of postoperative complications,total satisfaction of the study group was 7. 5%（3/40）,92. 5%（37/40） respectively,of the control group was 27. 5%（11/40）,75. 0%（30/40） respectively, the difference was significant（χ2=5. 54,4. 50;P〈0. 05） . Conclusion For elderly distal radius fractures,closed reduction and open reduction on Gartland-Werleyde efficacy and stability of the distal radioulnar joint have a cer-tain effect,but closed reduction treatment can significantly reduce operative time and blood loss,it can reduce the incidence of postoperative complications and improve patient satisfaction.