| 克氏针支撑固定与切开复位接骨板固定治疗中老年Colles骨折的临床疗效观察 |
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投稿时间：2024-07-17
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| 作者 | Author | 单位 | Address | E-Mail |
| 张峻玮 |
ZHANG Jun-wei |
山东省文登整骨医院创伤整复科, 山东 威海 264400 |
Department of Trauma and Reconstructive Surgery, Shandong Wendeng Osteopathic Hospital, Weihai 264400, Shandong, China |
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| 侯金永 |
HOU Jin-yong |
山东省文登整骨医院创伤整复科, 山东 威海 264400 |
Department of Trauma and Reconstructive Surgery, Shandong Wendeng Osteopathic Hospital, Weihai 264400, Shandong, China |
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| 李朝辉 |
LI Zhao-hui |
山东省文登整骨医院创伤整复科, 山东 威海 264400 |
Department of Trauma and Reconstructive Surgery, Shandong Wendeng Osteopathic Hospital, Weihai 264400, Shandong, China |
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| 马振元 |
MA Zhen-yuan |
山东省文登整骨医院创伤整复科, 山东 威海 264400 |
Department of Trauma and Reconstructive Surgery, Shandong Wendeng Osteopathic Hospital, Weihai 264400, Shandong, China |
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| 高祥 |
GAO Xiang |
山东省文登整骨医院创伤整复科, 山东 威海 264400 |
Department of Trauma and Reconstructive Surgery, Shandong Wendeng Osteopathic Hospital, Weihai 264400, Shandong, China |
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| 毕宏政 |
BI Hong-zheng |
山东省文登整骨医院创伤整复科, 山东 威海 264400 |
Department of Trauma and Reconstructive Surgery, Shandong Wendeng Osteopathic Hospital, Weihai 264400, Shandong, China |
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| 陈玲玲 |
CHEN Ling-ling |
山东省文登整骨医院创伤整复科, 山东 威海 264400 |
Department of Trauma and Reconstructive Surgery, Shandong Wendeng Osteopathic Hospital, Weihai 264400, Shandong, China |
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| 王海涛 |
WANG Hai-tao |
山东省文登整骨医院创伤整复科, 山东 威海 264400 |
Department of Trauma and Reconstructive Surgery, Shandong Wendeng Osteopathic Hospital, Weihai 264400, Shandong, China |
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| 聂伟志 |
NIE Wei-zhi |
山东省文登整骨医院创伤整复科, 山东 威海 264400 |
Department of Trauma and Reconstructive Surgery, Shandong Wendeng Osteopathic Hospital, Weihai 264400, Shandong, China |
18663103927@163.com |
| 成永忠 |
CHENG Yong-zhong |
中国中医科学院望京医院, 北京 100102 |
Wangjing Hospital of China Academy of Chinese Medical Sciences, Beijing 100102, China |
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| 奚小冰 |
XI Xiao-bing |
上海交通大学医学院附属瑞金医院, 上海 200025 |
Ruijin Hospital Affiliated to Medical College of Shanghai Jiaotong University, Shanghai 200025, China |
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| 期刊信息：《中国骨伤》2025年，第38卷，第1期，第18-24页 |
| DOI：10.12200/j.issn.1003-0034.20240482 |
| 基金项目:山东省自然基金面上项目(编号:ZR2020MH358);全国基层名老中医专家杨茂清传承工作室建设项目[编号:国中医药人教函(2018)133号];全国名老中医药专家杨茂清传承工作室建设项目[编号:国中医药人教函(2022)75号];威海市第三批中医重点专科(四肢创伤科)项目[编号:威卫计中医(2017)14号];威海市中医药科技面上项目(编号:2021N-02) |
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中文摘要:
目的: 比较闭合复位克氏针支撑固定与切开复位接骨板治疗中老年Colles骨折的近期临床疗效。
方法: 回顾性分析2018年1月至2023年1月收治的Colles骨折患者119例，其中男39例，女80例，年龄48~74(60.58±6.71)岁，受伤至手术时间1~13(5.29±2.52) d，按照手术方式分为克氏针固定组(克氏针组)及接骨板内固定组(接骨板组)。克氏针组68例，男21例，女47例;年龄49~74(61.15±6.24)岁;左侧41例，右侧27例。接骨板组51例，男18例，女33例;年龄48~72(59.78±5.71)岁;左侧31例，右侧20例。记录并比较手术时间、术中出血量、住院天数、住院费用、术后并发症，术前术后桡骨远端影像学参数(桡骨高度、尺偏角、掌倾角)，术后3、12个月采用Gartland-Werley和上肢功能障碍评分量表(disabilities of the arm，shoulder and hand，DASH)评分进行临床疗效评价。
结果: 两组患者术后均获随访，时间12~19(13.32±2.02)个月。克氏针组手术时间、术中出血量、住院天数、住院费用少于接骨板组[27.91(13.00，42.00) min vs 67.52(29.72，105.32) min，Z=-8.74，P=0.00;3.24(1.08，5.40) ml vs 21.91(17.38，26.44) ml，Z=-9.31，P=0.00;(8.38±2.63) d vs (11.40±2.78) d，t=-3.12，P=0.00;10 111.29 (6 738.98，13 483.60)元 vs 15 871.11(11 690.40，20 051.82)元，Z=-5.62，P=0.00]。克氏针组并发症2例，接骨板组1例，差异无统计学意义(P>0.05)。术后3个月克氏针组桡骨高度小于接骨板组[(11.45±1.69) mm vs (12.11±1.78) mm，t=-2.061，P=0.04]，尺偏角及掌倾角两者差异无统计学意义(P>0.05)。术后3个月克氏针组DASH评分、Gartland-werley评分较接骨板组高[(19.10±9.89)分 vs (13.47±3.51)分，t=4.34，P=0.00;(11.15±3.61)分 vs (6.41±2.75)分，t=8.13，P=0.00];术后12个月两组比较差异无统计学意义(P>0.05)。
结论: 与接骨板内固定相比，闭合复位克氏针支撑固定虽然对桡骨高度的恢复稍差，但术后12个月两组患肢功能评分无明显差异，但手术时间短，术中出血量少，住院时间短，花费少。 |
| 【关键词】骨质疏松 Colles骨折 克氏针 微创固定 接骨板 |
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| Clinical efficacy of open reduction and internal fixation with plates versus minimally invasive Kirschner wire fixation for osteoporotic Colles' fractures |
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ABSTRACT
Objective To compare the short-term clinical efficacy and safety of closed reduction with Kirschner wire fixation versus open reduction with plate fixation for treating osteoporotic Colles' fractures in middle-aged and elderly patients.
Methods Between January 2018 and January 2023,119 patients with Colles fractures were retrospectively analyzed,including 39 males and 80 females,aged from 48 to 74 years old with an average of(60.58±6.71) years old. The time from injury to operation ranged 1 to 13 days with an average of (5.29±2.52) days. According to the surgical method,they were divided into Kirschner wire fixation group (Kirschner wire group) and plate internal fixation group (plate group). In Kirschner wire group,there were a total of 68 patients,comprising 21 males and 47 females. The average age was (61.15±6.24) years old,ranged from 49 to 74 years old. Among them,41 cases involved the left side while 27 cases involved the right side. In the plate group,there were a total of 51 patients,including 18 males and 33 females. The average age was (59.78±5.71) years old ranged from 48 to 72 years old. Among them,there were 31 cases on the left side and 20 cases on the right side. The following parameters were recorded before and after the operation:operation time,intraoperative blood loss,hospitalization days,hospitalization expenses,postoperative complications,and radiographic parameters of distal radius (distal radius height,ulnar deviation angle,palmar tilt angle). The clinical efficacy was evaluated at 3 and 12 months after the operation using Gartland-Werley and disabilites of the arm shoulder and hand (DASH) scores.
Results The patients in both groups were followed up for a duration from 12 to 19 months with an average of(13.32±2.02) months. The Kirschner wire group exhibited significantly shorter operation time compared to the plate group 27.91(13.00,42.00) min vs 67.52(29.72,105.32) min,Z=-8.74,P=0.00. Intraoperative blood loss was also significantly lower in the Kirschner wire group than in the plate group 3.24(1.08,5.40) ml vs 21.91(17.38,26.44) ml,Z=-9.31,P=0.00. Furthermore,patients in the Kirschner wire group had a shorter length of hospital stay compared to those in the plate group (8.38±2.63) days vs (11.40±2.78) days,t=-3.12,P=0.00. Additionally,hospitalization cost was significantly lower in the Kirschner wire group than in the plate group 10 111.29(6 738.98,13 483.60) yuan vs 15 871.11(11 690.40,20 051.82) yuan,Z=-5.62,P=0.00. The incidence of complications was 2 cases in the Kirschner wire group and 1 case in the plate group,with no statistically significant difference(P>0.05). At 3 months postoprative,the radial height of the Kirschner wire group was found to be significantly smaller than that of the plate group,with measurements of (11.45±1.69) mm and (12.11±1.78) mm respectively (t=-2.06,P=0.04). However,there were no statistically significant differences observed in ulnar deviation angle and palmar tilt angle between the two groups (P>0.05). The DASH score and Gartland-Werley score in the Kirschner group were significantly higher than those in the plate group at 3 months post-operation (19.10±9.89) vs (13.47±3.51),t=4.34,P=0.00;(11.15±3.61) vs (6.41±2.75),t=8.13,P=0.00). However,there was no significant difference between the two groups at 12 months post-operation (P>0.05).
Conclusion Compared to plate internal fixation,closed reduction with Kirschner wire support fixation yields a slightly inferior recovery of radial height;however,there is no significant disparity in the functional score of the affected limb at 12 months post-operation. Nonetheless,this technique offers advantages such as shorter operation time,reduced intraoperative blood loss,decreased hospitalization duration,and lower cost. |
| KEY WORDS Osteoporosis Colles' fractures Kirschner wire Minimally invasive fixation Plate fixation |
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| 引用本文，请按以下格式著录参考文献： |
| 中文格式: | 张峻玮,侯金永,李朝辉,马振元,高祥,毕宏政,陈玲玲,王海涛,聂伟志,成永忠,奚小冰.克氏针支撑固定与切开复位接骨板固定治疗中老年Colles骨折的临床疗效观察[J].中国骨伤,2025,38(1):18~24 |
| 英文格式: | ZHANG Jun-wei,HOU Jin-yong,LI Zhao-hui,MA Zhen-yuan,GAO Xiang,BI Hong-zheng,CHEN Ling-ling,WANG Hai-tao,NIE Wei-zhi,CHENG Yong-zhong,XI Xiao-bing.Clinical efficacy of open reduction and internal fixation with plates versus minimally invasive Kirschner wire fixation for osteoporotic Colles' fractures[J].zhongguo gu shang / China J Orthop Trauma ,2025,38(1):18~24 |
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