手法复位联合小夹板外固定治疗老年桡骨远端骨折疗效分析

Clinical Efficacy of Manual Reduction Combined with Small Splinting in the Treatment of Distal Radius Fracture in the Elderly

目的研究分析手法复位联合小夹板外固定治疗老年桡骨远端骨折的临床效果。方法选取2020年1月至2021年1月长沙医学院附属株洲市人民医院收治的98例老年桡骨远端骨折患者作为研究对象,按照不同治疗方法将其分为研究组(49例)与对照组(49例)。研究组患者采用手法复位联合小夹板外固定治疗,对照组患者采用切开复位钢板内固定治疗,对比观察两组患者术后6个月腕关节功能恢复情况,掌倾角、尺偏角、桡骨高度与关节面台阶高度以及骨折再移位情况。结果术后6个月,研究组患者腕关节功能恢复为优者17例、良者29例、差者3例,与对照组患者腕关节功能恢复为优者14例、良者27例、差者8例无明显差异(Z=-1.198,P=0.231);研究组患者掌倾角、尺偏角明显小于对照组,桡骨高度明显矮于对照组,关节面台阶高度明显高于对照组(t=21.667、8.025、9.399、38.106,P均<0.001);研究组患者中有1例患者出现骨折再移位,对照组患者均未出现骨折再移位,两组间无明显差异(χ^(2)=1.010,P=0.315)。结论手法复位联合小夹板外固定在腕关节解剖结构复位中的效果虽不及切开复位钢板内固定,但能够获得与切开复位钢板内固定同等的腕关节功能恢复效果,并未增加患者骨折再移位风险,且操作更简单,患者更易接受,临床应用价值更高。

Objective To study the clinical efficacy of manual reduction combined with small splinting in the treatment of distal radius fracture in the elderly.Methods 98 aged patients with distal radius fracture,admitted into Zhuzhou People’s Hospital Affiliated to Changsha Medical University between January 2020 and January 2021 were enrolled as subjects,and divided into study group(n=49)and control group(n=49)based on different treatments they received.Patients in study group were treated with manual reduction combined with external fixation with small splint,while patients in control group were treated with open reduction and plate internal fixation.The rehabilitation of wrist functions,palmar tilt,ulnar inclination,radius height,articular surface step height,and re-displacement of fracture at six months after surgery were compared between the two groups.Results At six months after surgery,the rehabilitation of wrist functions was evaluated as excellent in 17 cases,good in 29 cases and poor in 3 cases in study group,which showed no statistically significant difference compared with control group-excellent in 14 cases,good in 27 cases and poor in 8 cases(Z=-1.198,P=0.231).The palmar tilt and ulnar inclination of patients in study group were obviously smaller than control group,the radius height was lower and the articular surface step height was higher in study group compared with that in control group(t=21.667,8.025,9.399 and 38.106,all P<0.001).One case developed redisplacement of fracture in study group,while no redisplacement of fracture happened in control group,between which there was no significant difference(χ^(2)=1.010,P=0.315).Conclusion Though the effect of manual reduction and external fixation with small splint in recovering the anatomic structure of wrist was not as good as that of open reduction and plate internal fixation,the former can achieve the equivalent effect in restoring the wrist functions,and doesn’t increase the risk of fracture redisplacement.Moreover,the operation of manual reduction and external fixation with small splint is much easier,and more acceptable by patients,presenting a much high value of clinical application.