老年Colles骨折夹板固定期间理筋康复对腕关节功能恢复的影响

Effect of Tendon Rehabilitation on Recovery of Wrist Joint Function During Splint Fixation of Elderly Colles Fractures

目的:观察老年Colles骨折夹板固定期间理筋康复对腕关节功能恢复的影响。方法:将符合纳入标准的老年Colles骨折患者120例随机分为2组各60例。对照组予手法整复小夹板外固定,拆除夹板后中药熏洗和功能锻炼;治疗组在对照组治疗方案的基础上于骨折3周后予理筋康复治疗,每周2次,治疗4周。分别测量整复前、整复后当天及拆除夹板时的桡骨高度、掌倾角和尺偏角;在拆除夹板1个月和6个月时采用Gartland-Werley评分进行腕关节功能评价及腕关节患者自评量表(PRWE)评分。结果:治疗组脱落2例,对照组脱落3例,共计115例患者完成了治疗,随访3~6个月,中位数4个月,均得到了骨性愈合。2组组内桡骨高度、掌倾角及尺偏角分别进行整复前-整复后当天-拆除夹板时比较,差异均有统计学意义(P<0.05),即均存在时间效应。2组组间在拆除夹板时桡骨高度、掌倾角及尺偏角分别比较,差异均无统计学意义(P>0.05),即均不存在分组效应,时间因素和分组因素不存在交互效应。治疗组在拆除夹板1个月和6个月时腕关节功能优良率分别为55.17%和86.21%,对照组分别为24.56%和70.18%,2组内1个月和6个月时优良率分别比较,2组1个月和6个月时组间优良率分别比较,差异均有统计学意义(P<0.05),治疗组均优于对照组。2组组内、组间分别在拆除夹板1个月和6个月时腕关节PRWE评分分别比较,差异均有统计学意义(P<0.05),治疗组评分均低于对照组。结论:老年Colles骨折夹板固定期间采用理筋康复治疗能维持骨折断端良好的解剖位置,有利于腕关节功能恢复,获得良好的临床疗效。

Objective:To observe the effect of tendon rehabilitation on the recovery of wrist joint function during splint fixation of elderly Colles fractures.Methods:A total of 120 elderly patients with Colles fractures who met the inclusion criteria were randomly divided into two groups,with 60 cases in each group.The control group was treated with external fixation of small splints and Chinese herbal fumigation and functional exercise after removal of splints.The treatment group was additionally given tendon rehabilitation three weeks after fractures based on the treatment of the control group.The patients were treated twice a week for four weeks.The radial styloid process height,palmar inclination angle and ulnar deviation angle were measured before the splint,on the day after the splint was removed and the moment when the splint was removed.The score of Gartland-Werley was used to evaluate wrist joint function and the score of Patient-Rated Wrist Evaluation(PRWE)was calculated at one month after the splint removal and six months after the splint removal.Results:There were two cases of detachment in the treatment group and three cases in the control group,with a total of 115 patients who had undergone the complete treatment.After three to six months of follow-up,with a median of four months,all patients had bony union.There were significant differences in radial styloid process height,palmar inclination angle and ulnar deviation angle before the splint,on the day after the splint was removed and the moment when the splint was removed in the two groups(P<0.05),indicating that time effect existed in all groups.There was no significant difference in radial styloid process height,palmar inclination angle and ulnar deviation angle between the two groups at the moment when the splint was removed(P>0.05),indicating that there was no grouping effect and no interaction effect between time factor and grouping factor.The excellent rates and good rates of wrist joint function were respectively 55.17%and 86.21%in the treatment group and 24.56%and 70.18%in the control group at one month after splint removal and six months after splint removal,differences being respectively significant(P<0.05),suggesting that the therapeutic effect in the treatment group was better than that in the control group.The scores of PRWE in both groups one month after splint removal and six months after splint removal were compared,differences being significant(P<0.05),the scores in the treatment group were lower than those in the control group.Conclusion:During the period of Colles fracture splint fixation,the application of tendon rehabilitation can maintain the good anatomical position of the fracture end,which is beneficial to the recovery of wrist joint function and can obtain great clinical effect.