手法复位石膏外固定法与切开复位钢板内固定法在骨质疏松性桡骨远端骨折治疗中的效果对比观察
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摘要
目的:比较手法复位石膏外固定法与切开复位钢板内固定法治疗骨质疏松性桡骨远端骨折的临床效果。方法:采取回顾性方法对本院2011~01/2013~12间80例骨质疏松性桡骨远端骨折患者的临床资料进行分析,手法复位石膏外固定法治疗的42例患者为外固定组,切开复位钢板内固定法治疗的38例患者为内固定组,对比两组的临床治疗效果。结果:内固定组患者腕关节功能优良率89.5%,外固定组患者腕关节功能优良率71.4%,内固定组高于外固定组,数据差异有统计学意义(P<0.05)。内固定组掌倾角、尺偏角、桡骨茎突与尺骨茎突远端差距以及骨折愈合时间分别为(12.5±1.2)°、(22.7±2.3)°、(1.4±0.2)mm、(11.7±1.2)周;外固定组掌倾角、尺偏角、桡骨茎突与尺骨茎突远端差距以及骨折愈合时间分别为(9.6±1.0)°、(12.6±2.1)°、(0.7±0.2)mm、(9.8±1.1)周;内固定组掌倾角、尺偏角、桡骨茎突与尺骨茎突远端差距以及骨折愈合时间均明显的大于外固定组,二者数据比较差异有统计学意义(P<0.05)。内固定组患者生活质量中的各项评分均明显的高于外固定组,二者的数据比较差异有统计学意义(P<0.05)。内固定组1例发生桡神经损伤,而外固定组1例畸形愈合,两组均无骨折不愈合的情况,恢复均较好。结论:临床中对于骨质疏松性桡骨远端骨折患者应用切开复位钢板内固定法在促进骨折复位和骨折愈合以及功能恢复方面明显的优于手法复位石膏外固定,并且极大提高患者的生活质量,值得临床中应用与推广。
Objective: To compare the clinical effect of manipulative reduction and plaster external fixation open reduction and plate fixation for treatment of osteoporotic fractures of the distal radius.Methods: A retrospective method for hospital from Jan2011 to Dec 2013 among 80cases of osteoporotic distal radius fractures were analyzed clinical data,manual reduction of 42 patients treated plaster external fixation for the external fixation group,open reduction and internal fixation method for the treatment of38 patients with internal fixation group,the clinical effect of contrast between the two groups.Results: Excellent wrist function of the internal fixation group was 89.5%,the external fixation group was 71.4%,it was higher than the internal fixation group,the data had statistically significant difference(P<0.05).Palmar angle,ulnar deviation,radial styloid and the gap between the distal ulnar styloid fracture healing time of the internal fixation group was(12.5± 1.2) °,(22.7± 2.3) °,(1.4± 0.2) mm,(11.7± 1.2) weeks; volar tilt,ulnar deviation,radial styloid and the gap between the distal ulnar styloid fracture healing time of the external fixation group was(9.6± 1.0) °,(12.6± 2.1) °,(0.7± 0.2) mm,(9.8± 1.1) weeks; volar tilt,ulnar deviation,radial styloid and the gap between the distal ulnar styloid fracture healing time of the internal fixation group was significantly greater than the external fixation group,both data was statistically significant(P<0.05).Quality of life in patients of the internal fixation group scores were significantly higher than the external fixation group,the difference between the two data was statistically significant(P<0.05).1patient had internal fixation of radial nerve injury in the internal fixation group,and 1patient had malunion in the external fixation group,there was no nonunion of the group.Conclusion: The clinical osteoporotic distal radius fractures were treated with open reduction and plate fixation in the promotion of fractures and fracture healing and functional recovery was significantly better than the manual reduction and plaster immobilization,and greatly improve the patient's life quality,worthy of clinical application and promotion.
Objective: To compare the clinical effect of manipulative reduction and plaster external fixation open reduction and plate fixation for treatment of osteoporotic fractures of the distal radius.Methods: A retrospective method for hospital from Jan2011 to Dec 2013 among 80cases of osteoporotic distal radius fractures were analyzed clinical data,manual reduction of 42 patients treated plaster external fixation for the external fixation group,open reduction and internal fixation method for the treatment of38 patients with internal fixation group,the clinical effect of contrast between the two groups.Results: Excellent wrist function of the internal fixation group was 89.5%,the external fixation group was 71.4%,it was higher than the internal fixation group,the data had statistically significant difference(P<0.05).Palmar angle,ulnar deviation,radial styloid and the gap between the distal ulnar styloid fracture healing time of the internal fixation group was(12.5± 1.2) °,(22.7± 2.3) °,(1.4± 0.2) mm,(11.7± 1.2) weeks; volar tilt,ulnar deviation,radial styloid and the gap between the distal ulnar styloid fracture healing time of the external fixation group was(9.6± 1.0) °,(12.6± 2.1) °,(0.7± 0.2) mm,(9.8± 1.1) weeks; volar tilt,ulnar deviation,radial styloid and the gap between the distal ulnar styloid fracture healing time of the internal fixation group was significantly greater than the external fixation group,both data was statistically significant(P<0.05).Quality of life in patients of the internal fixation group scores were significantly higher than the external fixation group,the difference between the two data was statistically significant(P<0.05).1patient had internal fixation of radial nerve injury in the internal fixation group,and 1patient had malunion in the external fixation group,there was no nonunion of the group.Conclusion: The clinical osteoporotic distal radius fractures were treated with open reduction and plate fixation in the promotion of fractures and fracture healing and functional recovery was significantly better than the manual reduction and plaster immobilization,and greatly improve the patient's life quality,worthy of clinical application and promotion.
引文
[1]邵芳.切开复位内固定及手法复位石膏外固定法治疗老年骨质疏松性桡骨远端骨折[J].实用临床医药杂志,2013,17(13):128~130,133
[2]Brogren E,Petranek M,Atroshi I.Cast-treated distal radius fractures:a prospective cohort study of radiological outcomes and their association with impaired calcaneal bone mineral density[J].Arch Orthop Trauma Surg,2015,135(7):927~933
[3]程国杰,吕发明,艾克巴尔,等.手法复位小夹板外固定治疗C型老年桡骨远端骨折的前瞻性随机对照临床试验[J].中国骨质疏松杂志,2012,18(7):636~640
[4]郭世明,石玲玲,郭志民,等.手法复位石膏外固定和切开复位钢板内固定治疗骨质疏松性桡骨远端骨折的比较研究[J].中医正骨,2015,27(4):15~20
[5]张立兴,梁云川,张斌,等.影响经皮球囊扩张椎体后凸成形术治疗骨质疏松性椎体压缩骨折效果的相关因素分析[J].中国医药导报,2013,10(12):51~53
[6]李相波.经皮椎体后凸成形术与经皮椎体成形术治疗绝经后女性T12、L1骨质疏松性压缩性骨折的临床研究[J].中国医药导报,2013,10(21):75~77
[7]庞启雄,张朝驹,白红军,等.切开复位内固定以及手法复位石膏外固定法在治疗老年骨质疏松性桡骨远端骨折效果及其对骨质疏松的影响评价[J].海南医学院学报,2013,19(11):1562~1565
[8]张燕翔,吴开丘,王和驹,等.桡骨远端骨折的临床治疗方案选择[J].海南医学,2011,22(12):98~99
[9]邱垂明,赵正兴,王东,等.三种不同固定方法治疗不稳定性桡骨远端骨折疗效观察[J].海南医学,2012,23(19):72~73
[10]徐文停,倪诚,喻任等.桡骨远端骨折手术与非手术治疗的疗效比较[J].中国骨与关节损伤杂志,2014,29(1):50~51
[11]建国,黄泳标.老年骨质疏松性肱骨近端骨折患者两种治疗方法的效果比较[J].中国医药导报,2012,09(5):49~50
[12]高天君,杨达宇.比较切开复位内固定和石膏固定治疗老年骨质疏松性桡骨远端骨折对患肢继发性骨质疏松和关节功能的影响[J].中国骨质疏松杂志,2012,18(3):245~247
[13]Rikli D,Goldhahn J,K?ch K,et al.Erratum to:The effect of local bone mineral density on the rate of mechanical failure after surgical treatment of distal radius fractures:a prospective multicentre cohort study including 249patients[J].Arch Orthop Trauma Surg,2015,135(7):1043
[14]朱卫国,郝永强.不同体位下防旋股骨近端髓内钉治疗老年骨质疏松性股骨粗隆间及股骨粗隆下骨折的效果观察[J].中国医药导报,2013,10(35):50~52
[15]李成功.手法复位与切开复位治疗老年桡骨远端不稳定骨折的比较研究[J].生物骨科材料与临床研究,2012,9(2):42~43,46
[2]Brogren E,Petranek M,Atroshi I.Cast-treated distal radius fractures:a prospective cohort study of radiological outcomes and their association with impaired calcaneal bone mineral density[J].Arch Orthop Trauma Surg,2015,135(7):927~933
[3]程国杰,吕发明,艾克巴尔,等.手法复位小夹板外固定治疗C型老年桡骨远端骨折的前瞻性随机对照临床试验[J].中国骨质疏松杂志,2012,18(7):636~640
[4]郭世明,石玲玲,郭志民,等.手法复位石膏外固定和切开复位钢板内固定治疗骨质疏松性桡骨远端骨折的比较研究[J].中医正骨,2015,27(4):15~20
[5]张立兴,梁云川,张斌,等.影响经皮球囊扩张椎体后凸成形术治疗骨质疏松性椎体压缩骨折效果的相关因素分析[J].中国医药导报,2013,10(12):51~53
[6]李相波.经皮椎体后凸成形术与经皮椎体成形术治疗绝经后女性T12、L1骨质疏松性压缩性骨折的临床研究[J].中国医药导报,2013,10(21):75~77
[7]庞启雄,张朝驹,白红军,等.切开复位内固定以及手法复位石膏外固定法在治疗老年骨质疏松性桡骨远端骨折效果及其对骨质疏松的影响评价[J].海南医学院学报,2013,19(11):1562~1565
[8]张燕翔,吴开丘,王和驹,等.桡骨远端骨折的临床治疗方案选择[J].海南医学,2011,22(12):98~99
[9]邱垂明,赵正兴,王东,等.三种不同固定方法治疗不稳定性桡骨远端骨折疗效观察[J].海南医学,2012,23(19):72~73
[10]徐文停,倪诚,喻任等.桡骨远端骨折手术与非手术治疗的疗效比较[J].中国骨与关节损伤杂志,2014,29(1):50~51
[11]建国,黄泳标.老年骨质疏松性肱骨近端骨折患者两种治疗方法的效果比较[J].中国医药导报,2012,09(5):49~50
[12]高天君,杨达宇.比较切开复位内固定和石膏固定治疗老年骨质疏松性桡骨远端骨折对患肢继发性骨质疏松和关节功能的影响[J].中国骨质疏松杂志,2012,18(3):245~247
[13]Rikli D,Goldhahn J,K?ch K,et al.Erratum to:The effect of local bone mineral density on the rate of mechanical failure after surgical treatment of distal radius fractures:a prospective multicentre cohort study including 249patients[J].Arch Orthop Trauma Surg,2015,135(7):1043
[14]朱卫国,郝永强.不同体位下防旋股骨近端髓内钉治疗老年骨质疏松性股骨粗隆间及股骨粗隆下骨折的效果观察[J].中国医药导报,2013,10(35):50~52
[15]李成功.手法复位与切开复位治疗老年桡骨远端不稳定骨折的比较研究[J].生物骨科材料与临床研究,2012,9(2):42~43,46