二夹板治疗前臂双骨折的生物力学测定与临床研究

Biomechanical experiment and clinical study on the treatment of radius-and ulna fracture in forearm by duble-splint

目的 :通过生物力学测定与临床研究 ,探讨二夹板外固定治疗前臂双骨折的生物力学原理和临床疗效及可行性。方法 :在生物力学实验研究中 ,取 8个新鲜成年男性尸体前臂标本 ,每一标本分别作“无夹板”、“二夹板”、“四夹板”外固定 ,分别在正常扭转、正常分骨、截断分骨、截断扭转状态进行生物力学测试 ,实验数据作统计学处理。在临床研究部分 ,则自 1997年 12月至 2 0 0 0年 12月 ,对 6 0例前臂双骨折患者进行前瞻性临床观察 ,分别予以手法复位 ,两夹和四夹 (连旋中板共五块夹板 )外固定治疗前臂双骨折。结果 :实验研究结果显示 :正常扭转状态下、截断扭转状态下与正常分骨状态下 ,“空白组”、“二夹组”与“四夹组”的组间差别均非常显著 (P <0 .0 1) ;截断分骨状态下、“空白组”、“二夹组”与“四夹组”的组间差别亦显著 (P <0 .0 5 )。通过临床观察可见 :“两夹组”与“四夹组”外固定效果接近 ,解除夹板后前臂旋转功能、腕关节功能恢复时间均为 3～ 6个月。结论 :实验研究表明 :“二夹组”无论抗旋转或分骨方面都明显优于“四夹组”。而临床研究亦显示二夹板外固定治疗前臂双骨折疗效满意 ,与传统的四夹板外固定治疗前臂双骨折比较 ,具有简便、易掌握、疗效可靠等特点 ,值得临床推广和使用。

睞bstract〕Objective To study the biomechanical principles and clinical feasibility of double-splint therapy for radius-and-ulna fracture in forearm by means of biomechanical experiment.and clinical study.Methods Eight forearm samples of fresh adult cadavers were enrolled in the study.On each sample,the extents of normal rotation,normal-bone-separation,cut-bone-separation,cut-bone-rotation were detected biomechanically in states of nosplint,double-splint,and four-splint successively.The harvested data were evaluated statistically.In the clinical study,from December1997 to December 2000,60 cases of radius-and-ulna fracture were divided randomly into two groups,treated them with manuplative reposition,and ,respectively fixed externally with double splints(A Group)and four splints(B Broup).Results In the biomechanical experiment,the extents of .normal rotation,normal-bone-separation,cut-bone-rotation were markedly different between every two states of nosplint,double-splint,and four-splint.(P<0.01);and,the extents of cut-bone-separation were also significantly different between every two states(P<0.05).In the clinical study,the,effects of external fixation of two groups were similar,both with unioning duration from 4 to 10weeks and recovering duration from 3 to 6 months in rotative function of forearms and motional function of wrists.Conclusion Two-splint therapy was superior tofour-splint therapy obviously in both rotation-resistance and bone-separation.Being simple,easily-mastered,reliable and with satisfactory effects,the double-splint therapy for radian-and-ulna fracture is worth popularizing and utilizing. 〔