纸夹板联合木夹板固定治疗闭合性桡骨远端骨折的临床研究

A clinical study of external fixation with paper splints and wooden splints for treatment of closed distal radius fractures

目的:观察纸夹板联合木夹板固定治疗闭合性桡骨远端骨折的临床疗效。方法:将符合要求的60例闭合性桡骨远端骨折患者随机分为2组,每组30例。手法复位后,联合固定组采用纸夹板联合木夹板固定,石膏固定组采用管形石膏固定。测量患侧桡骨高度、掌倾角、尺偏角,记录骨折愈合时间,采用疼痛视觉模拟量表(visual analogue scale,VAS)评分评价腕部疼痛程度,采用改良Green和O’Brien腕关节评分标准评价综合疗效。结果:治疗前2组患者腕部疼痛VAS评分比较,差异无统计学意义[(8.31±1.24)分,(8.27±1.41)分,t=1.415,P=0.257];治疗结束后7 d,联合固定组患者腕部疼痛VAS评分低于石膏固定组[(2.54±0.53)分,(4.27±0.42)分,t=6.132,P=0.018]。所有患者均获随访,随访时间3~12个月,中位数5个月。骨折均愈合,联合固定组的骨折愈合时间短于石膏固定组[(59.58±4.74)d,(70.73±6.37)d,t=8.555,P=0.021]。治疗结束后3个月,联合固定组的患侧桡骨高度高于石膏固定组、掌倾角及尺偏角均大于石膏固定组[(6.15±0.37)mm,(3.93±2.14)mm,t=7.564,P=0.035;7.52°±2.25°,3.53°±1.94°,t=9.682,P=0.018;16.44°±3.15°,10.76°±2.58°,t=9.877,P=0.016];综合疗效评价,联合固定组优14例、良12例、可4例,石膏固定组优6例、良15例、可8例、差1例,联合固定组的综合疗效优于石膏固定组(Z=-2.322,P=0.020)。结论:纸夹板联合木夹板固定治疗闭合性桡骨远端骨折,可以减轻腕部疼痛、纠正腕部畸形、促进骨折愈合,疗效优于管形石膏固定治疗。

Objective:To observe the clinical curative effects of external fixation with paper splints and wooden splints for treatment of closed distal radius fractures.Methods:Sixty patients with closed distal radius fractures were enrolled in the study and were randomly divided into 2 groups,30 cases in each group.All patients in the 2 groups were treated with manipulative reduction,followed by external fixation with paper splints and wooden splints in 30 cases(combination fixation group)and tubular plaster external fixation in the rest(plaster fixation group).The radial height,volar tilt angles and radial inclination angles were measured,and the fracture healing time was recorded.The wrist pain degree and the total clinical curative effects were evaluated by using pain visual analogue scale(VAS)scores and modified Green and O’Brien wrist scoring criterion respectively.Results:There was no statistical difference in wrist pain VAS scores between the 2 groups before the treatment(8.31±1.24 vs 8.27±1.41 points,t=1.415,P=0.257).The pain VAS scores were lower in combination fixation group compared to plaster fixation group at 7 days after the end of the treatment(2.54±0.53 vs 4.27±0.42 points,t=6.132,P=0.018).All patients in the 2 groups were followed up for 3-12 months with a median of 5 months.All fractures healed in the 2 groups,and the fracture healing time was shorter in combination fixation group compared to plaster fixation group(59.58±4.74 vs 70.73±6.37 days,t=8.555,P=0.021).The radial height was higher,the volar tilt angles and radial inclination angles were larger in combination fixation group compared to plaster fixation group at 3 months after the end of the treatment(6.15±0.37 vs 3.93±2.14 mm,t=7.564,P=0.035;7.52±2.25 vs 3.53±1.94 degrees,t=9.682,P=0.018;16.44±3.15 vs 10.76±2.58 degrees,t=9.877,P=0.016).The total clinical curative effects were evaluated at 3 months after the end of the treatment.Fourteen patients obtained an excellent result,12 good and 4 fair in combination fixation group;while 6 patients obtained an excellent result,15 good,8 fair and 1 poor in plaster fixation group.The combination fixation group surpassed the plaster fixation group in total clinical curative effects(Z=-2.322,P=0.020).Conclusion:External fixation with paper splints and wooden splints can relieve wrist pain,correct wrist deformity and promote fracture healing in treatment of closed distal radius fractures,and its curative effect is better than that of tubular plaster external fixation.