桡骨远端骨折新型夹板的临床验证及改良设计

Clinical verification and improved design of the new traction splint for distal radius fractures

背景:新型牵引型夹板是依据传统小夹板的"弹性固定"理论以及促进骨折愈合的"微动"理论设计研发的一款新型夹板,治疗桡骨远端骨折具有广阔的应用价值与应用前景。目的:通过对新型牵引型夹板进行临床验证来探讨其性能,并对其不足进行改良设计。方法:将40例桡骨远端骨折患者按照就诊时间顺序随机分为新型牵引型夹板组和石膏管型组,每组20例。分别在复位固定后即刻、固定2周、固定6周摄腕关节正侧位X射线片,根据X射线片对2组固定6周的骨折愈合情况进行对比;运用PACS系统分析测量固定后即刻、固定6周的桡骨高、掌倾角以及尺偏角;同时比较2组固定0,3,7,14 d的疼痛、肿胀程度,并按照Gartland和Werley(G-W)腕关节评分系统对腕关节功能进行评价。结果与结论:(1)新型牵引型夹板组在骨折愈合速度及减轻患肢的肿胀程度方面均显著优于石膏管型组,差异有显著性意义(P<0.05);(2)在骨折固定6周,新型牵引型夹板组的临床疗效要优于石膏管型组(P<0.05);骨折3个月后,2组临床疗效差异无显著性意义;(3)在复位后、固定6周桡骨高、掌倾角以及尺偏角方面新型牵引型夹板组与石膏管型组相比差异无显著性意义(P>0.05),在复位后与固定6周掌倾角变化值方面,石膏管型组要稍优于新型牵引型夹板组;(4)此外新型牵引型夹板与石膏管型治疗都存在不同程度的并发症,但在较严重并发症方面新型牵引型夹板发生率要少于传统石膏管型固定治疗;(5)提示新型牵引型夹板治疗桡骨远端骨折具有明显的优势和确切疗效,但也存在许多不足,需要在轻量化、外形、牵引结构以及内衬等方面不断地进行改良设计。

BACKGROUND： New traction splint is developed base on “elastic fixation” theory of traditional splint and “minimal movement” theory of promoting fracture healing, which exhibits broad application values and prospects in the treatment of distal radius fractures. OBJECTIVE： To explore the performance of the new traction splint by clinical research, and to improve its deficiencies. METHODS： Forty patients with distal radius fractures were randomly divided into trial （new traction splint） and control （plaster fixation） groups （n=20 per group）. The X-ray films of the wrist joint were performed immediately, 2 and 6 weeks postoperatively to compare the fracture healing. PACS system was used to measure the height of radius, palm inclination and ulnar deviation immediately and 6 weeks postoperatively. The pain and swelling degree at 0, 3, 7 and 14 days were compared. The wrist function was assessed according to Gartland and Werley evaluation system. RESULTS AND CONCLUSION： （1） The speed of fracture healing and swelling relief in the trial group were significantly better than those in the control group （P 〈 0.05）. （2） The curative efficacy at postoperative 6 weeks in the trial group was significantly superior to that in the control group （P 〈 0.05）, and the curative efficacy showed no significantly between two groups at postoperative 3 months. （3） There was no significant difference in the height of radius, palm inclination and ulnar deviation after reduction and 6 weeks after fixation between two groups （P 〉 0.05）. The change value of palm inclination in the control group was slightly superior to that in the trial group. （4） Different degrees of complications occurred in both groups, but the incidence of severe complications in the trial group was lower than that in the control group. （5） Our findings indicate that the new traction splint has obvious advantages and definite curative effect in the treatment of distal radius fracture, but there are many shortcomings. It needs to be improved in the aspects of light weight, shape, traction structure and inner lining.