复合夹板治疗移位型桡骨远端骨折的效果和医护配合研究

Effects and nursing cooperation of composite splint fixation in the treatment of displaced dis-tal radius fractures

目的探讨复合夹板治疗移位型桡骨远端骨折的效果和医护配合。方法回顾性分析2020年8月—2022年9月无锡市第九人民医院骨科采用自主设计的复合夹板固定移位型桡骨远端骨折患者25例,男性11例,女性14例;年龄32~79岁,平均56.9岁。护士配合医师实施骨折复位和复合夹板固定,以及牵引期间密切观察和指导患者学会如何正确使用牵引装置并观察治疗效果。采用Lidstr9m影像学分级评价骨折移位,采用Cooney评分和患者自行评估量表(PRWE)分别评价腕关节功能恢复。结果固定后1周肿胀评分(2.1±0.5)分。6例(24%)发生骨折再移位,与牵引带和夹板发生松弛未得到及时、正确处置有关。其中2例再次整复达Lidstr9m满意标准,1例未整复者继续夹板固定,另3例未达满意标准者改为手术治疗(手术率12%)。随访6~12个月,平均8.1个月。骨折均愈合,临床愈合时间5~8周,平均5.9周,无局部皮肤压疮和神经压迫症状。末次随访,桡骨高度(9.0±1.3)mm,掌倾角(8.0±3.1)°,尺偏角(22.3±2.2)°,掌屈度(41.4±11.0)°,背伸度(36.1±8.9)°,桡侧倾斜度(23.1±10.0)°,尺侧倾斜度(27.0±5.2)°,旋前(70.4±7.5)°,旋后(71.5±9.6)°,手握力达对侧(77.7±6.0)%,VAS(0.6±0.6)分,Cooney评分(87.9±8.6)分,腕关节功能优良率88%,PRWE评分(18.7±3.1)分。结论复合夹板固定移位型桡骨远端骨折的短缩移位率和手术率较低,使用安全;保持牵引带适当张力和指导患者学会正确使用牵引装置的护理工作,对治疗效果起重要作用。

Objective To investigate the effects and nursing cooperation of composite splint fixation in the treatment of displaced distal radius fractures.Methods From Aug.2020 to Sep.2022,25 patients with distal radi-us fractures fixed with self-designed composite splint fixators were retrospectively studied.There were 11 males and 14 females aged 32-79(mean 56.9)years.The nurses cooperated with doctors to conduct reduction and traction.Moreover,they closely observed and guided patients on how to correctly use the devices during traction.Fracture displacement was assessed using the Lidström imaging grading,and the wrist joint function recovery was evaluated by Cooney criteria and patient-rated wrist evaluation(PRWE),respectively.Results The swelling score at 1 week af-ter fixation was 2.1±0.5.Six cases(24%)had re-displacement,which was related to the relaxation of the traction belt without timely re-adjustment or correction.For these 6 cases,2 achieved satisfactory reduction after a second re-duction,1 continued splint immobilization without re-reduction,and the other 3 received surgery(surgery rate 12%).Patients were followed up for 6-12 months,mean 8.1 months.All fractures healed in 5-8 weeks,mean 5.9 weeks.No local bedsores or nerve compression symptoms was reported.At the last follow-up,the radial height was(9.0±1.3)mm,palmar inclination 8.0°±3.1°,ulnar declination 22.3°±2.2°,palmar flexion 41.4°±11.0°,dorsal extension 36.1°±8.9°,radial inclination 23.1°±10.0°,ulnar inclination 27.0°±5.2°,pronation 70.4°±7.5°,and supination 71.5°±9.6°.The hand grip strength recovered to 77.7%±6.0%of the contralateral side,the VAS was 0.6±0.6,Cooney criteria 87.9±8.6,the excellent and good rate of the wrist function reached 88%,and the PRWE scored 18.7±3.1.Conclusion The composite splint fixation for displaced distal radius fractures is safe and has a low incidence of fracture shortening and surgery.During the traction period,maintaining appropriate tension of the traction belt and good guidance for patients on how to use the traction devices play a crucial role in the therapeutic effect.