| 手术与石膏外固定治疗桡骨远端不稳定骨折疗效比较 |
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Received:August 25, 2012
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| 作者 | Author | 单位 | Unit | E-Mail |
| 彭斌 |
PENG Bin |
克拉玛依市中心医院骨二科,新疆 克拉玛依 834000 |
Second Department of Orthopaedics,Central Hospital of Xinjiang Kelamayi City,Kelamayi 834000,Xingjiang,China |
ckpb123456@yahoo.com.cn |
| 王健 |
WANG Jian |
克拉玛依市中心医院骨二科,新疆 克拉玛依 834000 |
Second Department of Orthopaedics,Central Hospital of Xinjiang Kelamayi City,Kelamayi 834000,Xingjiang,China |
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| 毛峰 |
MAO Feng |
克拉玛依市中心医院骨二科,新疆 克拉玛依 834000 |
Second Department of Orthopaedics,Central Hospital of Xinjiang Kelamayi City,Kelamayi 834000,Xingjiang,China |
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| 期刊信息：《中国骨伤》2013年26卷，第1期，第41-46页 |
| DOI：10.3969/j.issn.1003-0034.2013.01.011 |
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目的：有手术适应证的不稳定桡骨远端骨折采取保守治疗与手术治疗的疗效.
方法：采用非随机分组方法,将自2008年3月至2011年7月收治的桡骨远端不稳定骨折患者分别纳入手术治疗组和保守治疗组,其中手术治疗组男16例,女32例,年龄22～76岁,平均50.26岁;保守治疗组男10例,女27例,年龄42～79岁,平均51.12岁.两组患者创伤类型多为跌倒损伤,占92.94%(79/85),均为闭合性损伤,左侧41例,右侧44例.骨折按照AO分型： C1型12例,C2型32例,C3型38例,B3型3例.手术治疗组患者采用掌侧锁定加压钢板(LCP)固定治疗,保守治疗组患者采用手法复位石膏外固定治疗.末次随访时观察两组患者的腕关节主动活动范围、疼痛、主观评价、Gartland和Werley评分、Batra放射学评分、并发症等指标.
结果：手术治疗组有43例患者获得随访,平均随访时间8.03个月(4～15个月);保守治疗组有30例患者获得随访,平均随访时间6.54个月(2～9个月).两组患者在腕关节主动背伸旋后活动范围上的差异有统计学意义(分别为t=2.212,P < 0.05;t=2.392,P < 0.05);两组患者在腕关节尺侧疼痛比例的差异有统计学意义(χ2=5.71,P < 0.05);两组患者在主观评价得分之间的差异有统计学意义(Z=2.13,P < 0.05);两组患者在Gartland和Werley评分之间的差异有统计学意义(Z=2.36,P < 0.05);两组患者在Batra放射学评分之间的差异有统计学意义(Z=2.58,P < 0.05 ),两组患者在X线测量有桡骨远端短缩≥5 mm的比例上、桡骨高度(短缩)程度上的差异有统计学意义(分别为校正χ2=7.57,P < 0.05;t=2.016,P < 0.05);两组患者在骨折畸形愈合率、尺骨撞击综合征发病率、尺骨茎突骨折不愈合率等并发症的差异有统计学意义(分别为校正χ2=10.05,P < 0.05;χ2=8.39,P < 0.05;χ2=5.51,P < 0.05).
结论：对于有手术适应证的不稳定桡骨远端骨折,手术治疗在治疗结局的各项观察指标上要优于手法复位石膏外固定. |
| [关键词]:桡骨骨折 骨折固定术,内 石膏,外科 病例对照研究 |
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| Comparison of efficacy between the surgical treatment and plaster external fixation for treatment of unstable distal radius fractures |
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Abstract:
Objective:To compare the differences of the efficacy between the conservative treatment and surgical treatment for unstable distal radius fractures with surgical indications.
Methods:From March 2008 to July 2011,the patients with unstable distal radius fractures were devided into the surgical treatment group and the conservative treatment group in a non randomized manner. In the surgical group,there were 16 males and 32 females with an average age of 50.26 years old ranging from 22 to 76 years; in the conservative treatment group there were 10 males and 27 females with an average age of 51.12 years old ranging from 42 to 79 years. The patients of two groups were almost all with falling damage trauma,which accounting for 92.94% (79/85),all the patients were closed injury,41 cases were in the left side,and 44 cases in the right. Fracture in accordance with AO classification:C1 in 12 cases,C2 in 32 cases,C3 in 38 cases,B3 in 3 cases. Patients in the surgical treatment group were treated with volar locking compression plate (LCP) fixation and patients in the conservative were treated with manual reduction and plaster external fixation. The active wrist range of motion,pain assessment,subjective evaluation,Gartland and Werley score,Batra radiology score and complications were observed in the last follow-up.
Results:Forty-three patients in the surgical treatment group were followed up for an average time of 8.03 months (4 to 15 months); 33 paitents in the conservative group were followed up for an average time of 6.54 months (2 to 9 months). The difference of the wrist joint active dorsiflexion and supination rotation range in the two groups were statistically significant (t=2.212,P < 0.05; t=2.392,P < 0.05); the difference of the proportion of patients with ulnar wrist pain in the two groups was statistically significant (χ2=5.71,P < 0.05); the difference of patients' subjective evaluation score of two groups was statistically significant (Z=2.13,P < 0.05); the difference of Gartland and Werley score between the two groups was statistically significant (Z=2.36,P < 0.05);the difference of Batra radiology score in the two groups was statistically significant (Z=2.58,P < 0.05); the differences in the X-ray measurement of the proportion of distal radial shortening≥5 mm,the radial height (shortening) was statistically significant (for the correction χ2=7.57,P < 0.05;t=2.016,P < 0.05); the differences of malunion rate,ulnar impaction syndrome,the incidence rate of ulnar styloid fracture nonunion of two groups was statistically significant (adjusted χ2=10.05,P < 0.05; χ2=8.39,P < 0.05; χ2=5.51,P < 0.05).
Conclusion:For patients with surgical indications for unstable distal radius fractures,every indicator of the outcome after surgery in the treatment is better than that of the manipulative reduction and plaster fixation. |
| KEYWORDS:Radius fractures Surgical procedures,operative Casts,surgical Case-control studies |
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| 引用本文，请按以下格式著录参考文献： |
| 中文格式: | 彭斌,王健,毛峰.手术与石膏外固定治疗桡骨远端不稳定骨折疗效比较[J].中国骨伤,2013,26(1):41~46 |
| 英文格式: | PENG Bin,WANG Jian,MAO Feng.Comparison of efficacy between the surgical treatment and plaster external fixation for treatment of unstable distal radius fractures[J].zhongguo gu shang / China J Orthop Trauma ,2013,26(1):41~46 |
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