两种石膏固定治疗桡骨远端骨折的效果比较

Comparison effect of two kinds of plaster fixation in the treatment of distal radius fractures

目的比较管型石膏与石膏托固定治疗桡骨远端骨折的疗效是否存在差异。方法对51例桡骨远端骨折患者手法复位后采用管型石膏固定(29例)或石膏托固定(22例)治疗。其中一次性石膏固定20例,二次更换体位固定31例。对患者骨折后、第1次整复固定后、第2次固定后、骨折愈合时X线片进行比较,在PACS系统上测量出掌倾角、尺倾角、桡骨短缩程度的数值。结果 51例骨折愈合时桡骨短缩程度为(2.45±2.19)mm,与整复固定后的(1.14±1.30)mm相比进一步加剧,差异有统计学意义(P<0.05)。管型石膏固定和石膏托固定在骨折愈合时的桡骨短缩发生率比较差异无统计学意义(P>0.05)。一次性石膏固定和二次更换体位石膏固定的桡骨短缩发生率比较差异无统计学意义(P>0.05);但一次性石膏固定的患者在骨折愈合时的桡骨短缩程度为(2.00±1.26)mm,二次更换体位石膏固定为(2.75±2.60)mm,差异有统计学意义(P<0.05)。结论手法复位+石膏外固定治疗桡骨远端骨折仍存有明显的桡骨远端短缩。管型石膏固定和石膏托固定效果并无差别,过早行二次更换石膏固定可能加剧桡骨短缩。

Objective To investigate whether there is difference in the treatment of distal radius fractures between the plaster cast and plaster slab fixation. Methods The 51 cases of distal radius fractures underwent plaster cast fixation（ 29 cases） and plaster slab fixation（ 22 cases）. Primary plaster fixation was 20 cases and 31 cases underwent secondary plaster fixation. The radius palmar inclination,ulnar inclination and radius shortening of distal radius fractures were measured in PACS system on the X-ray film,when distal radius fractures,primary plaster fixation,secondary plaster fixation and after fracture healing. Results The radius shortening after fracture healing as（ 2. 45 ± 2. 19）mm was more shorten than the radius shortening of primary plaster fixation as（ 1. 14 ± 1. 30） mm,the shortening degree was further intensified,the difference had statistical significance between the two groups（ P〈0.05）. The incidence rate of radius shortening had no statistical significance between the plaster cast group and plaster slab group after fracture healing（ P〉0.05）. The incidence rate of radius shortening had no statistical significance between primary plaster fixation group and secondary plaster fixation group after fracture healing（ P〉0.05）. But the radius shortening of primary plaster fixation group was（ 2. 00 ± 1. 26） mm after fracture healing,and the secondary plaster fixation group was（ 2. 75 ± 2. 60） mm,the difference had statistical significance between the two groups（ P〈0.05）. Conclusions Manual reduction and plaster external in fracture of distal radius have significant radius shortening. The treatment effects have no difference between the plaster cast and plaster slab. A premature secondary plaster fixation may exacerbate the radius shortening.