“过伸推按抖折手法”联合改良夹板治疗桡骨远端伸直型骨折29例

29 Cases Clinical Study on Extension Fracture of Distal Radius with“Hyperextension Push and Shake”Combined with Modified Splint

目的:观察改良正骨疗法“过伸推按抖折手法”联合改良夹板固定治疗中老年桡骨远端伸直型骨折的临床疗效及对复位后骨折再移位、皮肤挤压伤发生率的影响。方法:选取2020年1月至2021年3月收治的29例中老年桡骨远端伸直型(Colles)骨折患者,均为摔倒伤后即刻就诊的新鲜闭合性骨折。运用改良后的中医正骨“过伸推按抖折法”联合改良夹板进行治疗,治疗后8周观察复位后骨折再移位、皮肤挤压伤发生率,评估治疗前后桡骨远端的高度、掌倾角、尺偏角、VAS疼痛评分改善情况,针对腕关节功能恢复采用Cooney评分进行疗效分析评估。结果:29例患者全部获得了8周的随访,均采用本方法一次性复位治疗,复位后骨折端再移位1例(发生率为3.45%),均未出现皮肤挤压性损伤情况。治疗后8周桡骨远端的高度、掌倾角、尺偏角、VAS疼痛评分均较治疗前改善明显,差异有统计学意义(P<0.05)。所有患者均未出现畸形愈合、神经血管损伤等并发症。综合腕关节功能Cooney评分疗效评价:优18例,良11例,优良率为100%。结论:运用改良的正骨疗法“过伸推按抖折手法”联合改良夹板固定治疗中老年桡骨远端伸直型闭合性骨折,明显降低了复位后骨折再移位发生率、皮肤挤压伤率,其具有操作手法安全、复位精准、固定稳固、腕关节功能恢复好等优点,值得临床推广应用。

Objective:To observe the clinical efficacy of modified bone setting technique of“hyperextension pushing and shaking”combined with modified splint fixation on the treatment of extended fracture of the distal radius and its efficacy on the incidence of bone displacement at the fracture end and skin crush injury after reduction.Methods:A total of 29 middle-aged and elderly patients with Colles fractures were selected from January 2020 to March 2021,all of which were fresh closed fractures immediately after fall injury.They were treated with modified bone setting technique of“hyperextension pushing and shaking”combined with modified splint fixation for 8 weeks.The incidence of fracture re displacement and skin crush injury after reduction were observed 8 weeks after treatment.The improvement of distal radius height,palmar inclination,ulnar deviation and VAS pain score before and after treatment were evaluated.Cooney score was used to analyze and evaluate the curative efficacy for the recovery of wrist function.Results:All the 29 patients were followed up for 8 weeks,and all of them were treated with one-time reduction by this method.The fracture end was displaced in 1 case,with an incidence of 3.45%,and no skin compression injury occurred after reduction.The height of distal radius,palmar Angle,ulnar deviation Angle and VAS pain score at 8 weeks after treatment were significantly improved compared with those before treatment with statistically significant differences(P<0.05).None of the patients had malunion,neurovascular injury and other complications.In the treatment group,18 cases were excellent and 11 cases were good,with an excellent and good rate of 100%.Conclusion:The modified bone setting technique of“hyperextension pushing and shaking”combined with modified splint fixation can significantly reduce the incidence of fracture end shift again after reset,skin squeeze the damage rate.It has the advantages of reliable safety,accurate reduction,stable fixation and good recovery of wrist function,which is worthy of clinical promotion.