单臂一体可调式外固定支架配合克氏针撬拨复位联合消定膏治疗桡骨远端骨折的临床效果

Clinical efficacy of unilateral adjustable external fixator with percutaneous Kirschner wire poking reduction combined with Xiaoding ointment in the treatment of distal radius fractures

目的观察单臂一体可调式外固定架配合克氏针撬拨复位联合消定膏治疗桡骨远端骨折的临床疗效,为外敷中药参与骨折的治疗提供疗效依据。方法本研究选取2021年6月至2022年7月在白银市中西医结合医院骨科与靖远县人民医院骨科就诊的桡骨远端骨折患者,随机将60例患者分为对照组和观察组,每组各30例;对照组予患者行手法复位配合克氏针撬拨复位,可单臂一体调式外固定架固定,术后功能锻炼,定期调整外固定架;观察组在对照组治疗方案的基础上术后予患者腕关节周围外敷消定膏;比较两组治疗前、后VAS评分、腕关节肿胀评分、骨折临床愈合时间,使用患者PRWE自评量表及Gartland-Werley腕关节功能评分进行腕关节功能评定,并通过PACS影像学系统测量治疗前后掌倾角、尺偏角、桡骨高度恢复情况。结果术后第4周观察组VAS疼痛评分低于对照组,差异有统计学意义(P<0.05)。术后第3周观察组腕关节肿胀评分为低于对照组,差异有统计学意义(P<0.05);第4周开始两组患者腕关节肿胀完全消退,差异无统计学意义(P>0.05)。观察组骨痂生长明显优于对照组,差异有统计学意义(P<0.05)。观察组PRWE评分、Garland-Werley评分明显优于对照组,差异有统计学意义(P<0.05);术后两组患者掌倾角、尺偏角、桡骨高度均基本恢复正常,差异无统计学意义(P>0.05)。结论单臂一体可调式外固定支架配合克氏针撬拨复位联合消定膏治疗桡骨远端骨折临床疗效显著,患者受伤部位疼痛、肿胀程度、骨折愈合情况明显优于对照组,临床不良反应少,值得临床推广。

Objective To observe the clinical efficacy of unilateral adjustable external fixator with percutaneous Kirschner wire poking reduction combined with Xiaoding ointment in the treatment of distal radius fractures,so as to provide a basis for the treatment of fractures with topically applied Chinese medicine.Methods A total of 60 patients with distal radius fractures who attended the Department of Orthopaedics of Baiyin Integrated Traditional Chinese and Western Medicine Hospital and Jingyuan County People’s Hospital from June 2021 to July 2022 were selected and randomly divided into a control group(n=30)and an observation group(n=30).The control group received m anipulative repositioning combined with percutaneous Kirschner wire poking reduction and unilateral adjustable external fixator,plus postoperative functional exercise and periodic adjustment of the external fixator.The observation group received postoperative topical application of Xiaoding ointment around the wrist joint on the basis of the treatment plan for the control group.The Visual Analogue Scale(VAS)score,wrist swelling score and clinical healing time of the fractures before and after the treatment were compared between the two groups.Wrist function was assessed using the Patient-Rated Wrist Evaluation(PRWE)and the Gartland-Werley Wrist Function Score,and the recovery of palmar inclination angle,ulnar deviation angle and radial height was measured by Picture Archiving and Communication System(PACS)after treatment.Results The VAS scores in the observation group were significantly lower than those in the control group at Week 4 postoperatively,with statistically significant difference(P<0.05).The wrist swelling scores in the observation group were significantly lower than those in the control group at Week 3 postoperatively,with statistically significant difference(P<0.05).The wrist swelling in both groups completely subsided from Week 4 onwards,with no statistically significant difference(P>0.05).The bone callus growth in the observation group was significantly better than that in the control group(P<0.05).The PRWE and Garland-Werley scores in the observation group were significantly higher than those in the control group,with statistically significant differences(P<0.05).The palmar inclination angle,ulnar deviation angle and radial height of the two groups were basically restored to normal after the operation,with no statistically significant differences between the two groups(P>0.05).Conclusion The unilateral adjustable external fixator combined with percutaneous Kirschner wire poking reduction and Xiaoding ointment is clinically more effective than the treatment plan in the control group in the treatment of distal radius fracture in terms of relieving pain and swelling and promoting fracture healing of the injured area,with fewer clinical adverse reacti ons.Therefore,it is worth of clinical promotion.