老年桡骨远端骨折的治疗方法研究

Treatment of distal radius fractures in the elderly

目的通过对比手术与非手术治疗老年桡骨远端骨折的疗效,寻找老年桡骨远端骨折适宜的治疗方法。方法选取北京老年医院2012年3月至2016年9月采用手法复位石膏外固定(非手术组,72例)及切开复位内固定(手术组,56例)治疗老年人桡骨远端骨折病例128例。骨折类型按AO分型:非手术组,A型33例,B型23例,C型16例;手术组,A型10例,B型12例,C型34例。对非手术组与手术组治疗的优良率采用χ2检验进行比较。结果128例患者中119例获得随访,随访时间6~24个月,平均(15.2±1.9)个月。对两组患者腕关节功能评定依据Cooney功能评分标准:手术组优良率高于非手术组(94.6%vs 83.3%),二者比较差异有统计学意义(χ2=0.67,P=0.037)。两组患者并发症:非手术组手法复位外固定失败转为手术治疗者5例;手术组有1例切口感染,1例骨折延迟愈合。结论切开复位内固定在治疗老年桡骨远端骨折中较手法复位石膏外固定能够取得更好的治疗效果,但对于稳定或相对稳定老年桡骨远端骨折,手法复位石膏外固定仍可作为首选治疗方法。

Objective To find the best treatment method by comparing the curative effect of surgical and non-surgical treatment of distal radius fractures in the elderly.Methods From March 2012 to September 2016,128 cases of distal radius fractures in the elderly from Beijing Geriatric Hospital were treated by manual reduction and plaster external fixation(non-operative group,72 cases)and open reduction and internal fixation(operative group,56 cases).According to the AO classification,there were 33 cases of type A,23 cases of type B,and 16 cases of type C in the non-operative group,and there were 10 cases of type A,12 cases of type B,and 34 cases of type C in the operative group.The Chi-square test was used to compare the excellent/good rate between the non-operative group and operative group.Results One hundred and nineteen patients were followed for 6 to 24 months,with an average period of(15.2±1.9)months.The wrist function was assessed according to the Cooney's functional scoring criteria,and the excellent/good rate was 83.3%in the non-operative group and 94.6%in the operation group.Conclusion For elderly patients with distal radius fracture,the excellent/good rate of open reduction and internal fixation is higher than that of manual reduction and gypsum external fixation.For stable or relatively stable distal radius fracture,manual reduction is still the preferred treatment.