夹板固定治疗桡骨远端Frykman Ⅷ型骨折34例

Application of Splint in Treatment of Type Frykman Ⅷ Fracture of Distal Radius

目的:对比手法整复夹板固定与单纯桡骨远端内固定治疗桡骨远端FrykmanⅧ型骨折的近期疗效和并发症,探讨夹板固定对尺侧柱损伤恢复的影响。方法:采用匹配、配对方法设计临床研究,要求性别相同、年龄相近、治疗后桡骨远端解剖学评分等级和尺骨茎突骨折类型一致,手法整复夹板固定治疗者纳入夹板组,单纯行桡骨远端钢板固定治疗者纳入内固定组,共配对34对(68例)。结果:随访至治疗后12周,桡骨远端骨折均愈合良好。夹板组出现尺侧柱并发症9例,内固定组24例(P<0.05)。通过Bunger的Colles骨折复位解剖学评分标准进行评估,夹板组优良率79.4%;内固定组97.1%(P<0.05)。Gartland-Werley腕关节功能评分,夹板组优良率91.2%,内固定组64.7%(P<0.05)。夹板组腕关节桡尺偏活动度、旋前及旋后活动度分别为健侧的(81.4±6.8)%、(80.3±10.2)%,内固定组分别为(76.8±8.0)%、(71.4±8.5)%(P<0.05)。夹板组手捏力为健侧的(73.1±6.5)%,内固定组为(69.8±6.4)%(P<0.05)。结论:手法整复夹板固定治疗终末桡骨远端骨折,虽解剖学评分不及单纯桡骨远端内固定治疗,但获得了更满意的腕关节功能,腕关节桡尺偏活动度、旋前及旋后活动度范围优于后者,且因尺侧柱损伤引起的相关并发症发生率低于后者。

Objective To compair the short-term efficacy and complications for manipulative reduction and splint therapy and simple distal radius internal ？xation in the treatment of type FrykmanⅧ fracture of distal radius. Methods A pair-matched clinical research was performed. Matching requirements were as follows： the same gender, the similar age, the same anatomical distal radius grade after treatment and the same type of ulnar styloid fracture. Patients treated with manipulative reduction and splint ？xation were assigned to the splint group, and patients treated with simple distal radius plate ？xation were assigned to the internal ？xation group. A total of 34 pairs （68 cases） were involved. Results All distal radius fractures were healed well in the two groups 12 weeks after treatment. Ulnar column complications occurred in 9 patients （26.5%） in the splint group, and 24 patients （70.6%） in the internal ？xation group, the difference was statistically signi？cant. According to the anatomical reduction standard for Colles fracture proposed by Bunger, the excellent and good rates in the splint group and internal ？xation group at the end of the follow-up were 79.4% and 97.1%, showing signi？cant difference between the two groups. According to the Gartland-Werley score, in the splint group and the internal ？xation group, the excellent and good rates were 91.2% and 64.7%, showing signi？cant difference between the two groups. The activity ranges of the wrist radial ulnar deviation, pronation and supination of the contralateral side were （81.4±6.8）%, （80.3±10.2）% in the splint group, and （76.8±8）%, （71.4±8.5）% in the internal fixation group, the differences were statistically significant. The hand pinching force of the injured wrist was（73.1±6.5）% of the contralateral side in the splint group, and （69.8±6.4）% in the internal ？xation group, the difference was statistically signi？cant. Conclusion At the end of the treatment, the anatomic score of distal radius in the splint group was less than that in the simple distal radius internal ？xation group. However, the splint group showed both better function of wrist joint and less complication than the internal ？xation group.