滑轮悬吊牵引复位结合自制小夹板固定治疗伸直型桡骨远端骨折

Clinical observation on pulley suspension traction reduction combined with self-made splint fixation for the treatment of extended distal radius fracture

目的:探讨滑轮悬吊牵引复位结合自制小夹板固定治疗伸直型桡骨远端骨折的临床疗效。方法:自2017年12月至2019年12月将收治的60例伸直型桡骨远端骨折患者分为观察组和对照组,每组30例。观察组男12例,女18例;年龄50~75(59.63±8.08)岁;骨折按照AO分型,A2型25例,A3型5例;采用滑轮悬吊牵引复位配合自制小夹板固定。对照组男11例,女19例;年龄52~76(59.77±8.03)岁;按照AO分型,A2型24例,A3型6例;采用传统手法复位配合自制小夹板固定。比较两组患者治疗前后桡骨高度、尺偏角、掌倾角情况,并采用改良Green和O’Brien腕关节评分标准评价临床疗效。结果:60例患者均获得随访,时间11~13(11.90±0.80)个月;拆除夹板时间42~60(50.20±4.94)d,拆除夹板后X线片显示所有骨折骨性愈合,关节面平整。观察组治疗前桡骨高度、尺偏角、掌倾角分别为(4.57±1.16)mm、(12.83±3.25)°、(-21.17±3.36)°,治疗8周后分别为(10.10±1.75)mm、(24.30±3.16)°、(9.40±2.13)°;对照组治疗前桡骨高度、尺偏角、掌倾角分别为(4.50±1.43)mm、(12.83±3.10)°、(-21.50±3.38)°,治疗8周后分别为(8.90±1.24)mm、(21.20±2.91)°、(6.16±2.94)°;治疗前两组桡骨高度、尺偏角和掌倾角比较差异无统计学意义(P>0.05);治疗8周后观察组桡骨高度、尺偏角和掌倾角均较对照组显著改善(P<0.05)。末次随访时观察组改良Green和O’Brien腕关节评分(90.97±7.92)分与对照组(84.77±9.14)分比较差异有统计学意义(t=2.807,P<0.05);其中观察组优18例,良10例,可2例;对照组优10例,良15例,可3例,差2例;两组比较差异有统计学意义(P<0.05)。结论:采用滑轮悬吊牵引复位结合自制小夹板固定治疗伸直型桡骨远端骨折,比传统手法牵引复位固定更具优越性,牵引稳定可靠,复位效果好,并能获得更好的腕关节功能,临床可根据患者的实际情况选择应用。

Objective:To explore clinical effects of pulley suspension traction reduction combined with self-made splint fixation in treating extended distal radius fracture.Methods:From December 2017 to December 2019,60 patients with extended distal radius fractures were divided into observation group and control group,30 patients in each group.In observation group,there were 12 males and 18 females,aged from 50 to 75 years old with an average of(59.63±8.08)years old;according to AO classification,25 patients were type A2 and 5 patients with type A3;fractures were fixed by pulley suspension traction and self-made splint.In control group,there were 11 males and 19 females,aged from 52 to 76 years old with an average of(59.77±8.03)years old;according to AO classification,24 patients were with type A2 and 6 patients were type A3;fractures were treated by conventional manipulation with self-made splint fixation.The radius height,ulnar angle and palmar angle between two groups were compared before and after treatment,and clinical effects were evaluated by advanced Green and O'Brien wrist joint scoring after treatment.Results:All patients were followed up from 11 to 13 months with an average of(11.90±0.80)months.The splint was removed for 42 to 60 days with an average of(50.20±4.94)days.After removal of splint,X-rays indicated that all patients obtained bone healing with smooth of joint surface.In observation group,radius height was(4.57±1.16)mm,ulnar angle was(12.83±3.25)°,palmar angle were(-21.17±3.36)°respectively before treatment,(10.10±1.75)mm,(24.30±3.16)°,(9.40±2.13)°respectively at 8 weeks after treatment;in control group,radius height,ulnar angle,palm angle were(4.50±1.43)mm,(12.83±3.10)°,(-21.50±3.38)°respectively before treatment,and(8.90±1.24)mm,(21.20±2.91)°,(6.16±2.94)°respectively at 8 weeks after treatment;there were no significant difference in radius height,ulnar deviation angle and palmar inclination between two groups before treatment(P>0.05);radius height,ulnar deviation angle and palmar inclination angle of between two groups were significantly improved at 8 weeks after treatment(P<0.05),and observation group was significantly better than that of control group(P<0.05).Green and O'Brien wrist score of observation group was 90.97±7.92 at follow-up ranged from 11 to 13 months with an average of(11.90±0.80)months,which was significantly higher than that of control group(84.77±9.14)(t=2.807,P<0.05);in observation group,18 patients got excellent result,10 good and 2 fair;in control group,10 patients got excellent result,15 good,3 fair and 2 poor;there was siginifcantly difference between two groups(Z=-2.15,P<0.05).Conclusion:Compared with conventional manual traction and reduction,pulley suspension traction reduction combined with self-made splint fixation for the treatment of extended distal radius fracture has more advantages with stable and reliable traction,good reduction,and better wrist joint function.It could be selected and applied according to the actual situation of patients.