杉树皮夹板联合早期石膏托外固定治疗B型老年桡骨远端骨折

Treatment of Type B Distal Radius Fracture in the Elderly with Fir Bark Splint Combined with Early Plaster External Fixation

目的:探讨手法复位杉树皮夹板联合早期石膏托外固定治疗B型老年桡骨远端骨折的临床疗效及优越性。方法:采用单中心对照试验,2020年6月—2022年5月芜湖市中医医院骨科急诊要求保守治疗的老年桡骨远端骨折患者,分为2组,联合外固定组40例,男16例,女24例,年龄65~78岁,平均年龄68.3岁;夹板外固定组40例,男17例,女23例,年龄65~76岁,平均年龄67.8岁。所有病例均行手法复位,复位后第3天及第1、2、6周来院复查,其中第2、6周复查X线片,观察骨折对位、对线及愈合情况,评估患肢功能恢复、骨质疏松情况。结果:77例患者获随访3~12个月,平均随访6.2个月,3例失访。记录伤后6周尺偏角、掌倾角、桡骨高度的改善情况,第2掌骨骨质疏松情况,采用腕关节患者自评量表和上肢功能评分表评价伤后6个月及1年功能恢复情况,并行统计学分析。结论:手法复位杉树皮夹板外固定能够较好地维持复位后骨折的对位,而早期联合石膏托外固定,可以维持复位后的特殊体位,且不影响后期功能康复,适用于要求保守治疗的老年桡骨远端骨折患者。

Objective:To explore the clinical efficacy and superiority of manual reduction of fir bark splint combined with early plaster external fixation in the treatment of type B distal radius fracture in the elderly.Methods:A singlecenter controlled trial was performed.Elderly patients with distal radius fracture who required conservative treatment in the orthopedic emergency department of Wuhu Traditional Chinese Medicine Hospital from June 2020 to May 2022 were divided into two groups.There were 40 cases in the combined external fixation group,including 16 males and 24 females,aged 65-78 years old,with an average age of 68.3 years old;there were 40 cases in the splint external fixation group,including 17 males and 23 females,aged 65-76 years old,with an average age of 67.8 years old.All cases underwent manual reduction and came to the hospital for reexamination on the 3rd day and 1,2,and 6 weeks after reduction.X-rays were reexamined at 2 and 6 weeks to observe the fracture alignment,alignment and healing,and to evaluate the functional recovery and osteoporosis of the affected limb.Results:77 patients were followed up for 3 to 12 months,with an average follow-up of 6.2 months,and 3 patients were lost to follow-up.The improvement of ulnar deviation angle,palmar inclination angle,and radius height at 6 weeks after injury,as well as osteoporosis of the second metacarpal bone were recorded.The wrist joint patient self-rating scale and upper limb function score table were used to evaluate the functional recovery at 6 months and 1 year after injury,and statistical analysis was performed in parallel.Conclusion:Manual reduction and fir bark splint external fixation can better maintain the alignment of the fracture after reduction,and early combined plaster splint external fixation can maintain the special position after reduction without affecting the functional rehabilitation in the later stage.It is suitable for elderly patients with distal radius fractures who require conservative treatment.