不同方法治疗桡骨远端不稳定骨折的临床疗效分析(1)
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[摘要] 目的 分析用不同方法治疗桡骨远端不稳定骨折的疗效。 方法 分析75例桡骨远端不稳定骨折的治疗，均先采用手法复位前臂石膏夹固定治疗，其中27例维持石膏固定4～8周，后拆除石膏进行功能锻炼；23例采用“T”型钢板固定，25例用外固定架固定治疗，分别进行骨折的功能评分，比较不同方法的优良率。 结果 75例均获随访，随访时间6～18个月，功能评分外固定支架组优良率为88.0%，“T”型钢板组为91.3%，石膏托组为44.4%，其中外固定支架组和“T”形钢板内固定组比较差异无统计学意义(P > 0.05)，但两组均明显优于石膏托外固定组(P < 0.05)。 结论 对于桡骨远端不稳定骨折，外固定支架固定简单、安全、微创，临床效果好。
[关键词] 桡骨远端骨折；外固定支架；内固定；石膏固定
[中图分类号] R683.41 [文献标识码] A [文章编号] 1674-4721(2012)02(a)-0045-03
Effect compared on unstable distal radius fracture by three different fixations
LAN Haifeng PENG Weixiong WU Shaojian ZHAO Ziping
Department of Orthopedics, Liwan Hospital of Guangzhou Medical College, Guangzhou 510170, China
[Abstract] Objecctive To analyse the clinical result after different treatment on unstable distal radius fractures. Methods There were 75 cases of unstable distal radius fractues, all of which were treated with close diaplasis and external plaster splint fixation first. Then 27 cases in 75 cases were maintained the external plaster splint fixation for 4 to 8 weeks, 23 cases in 75 cases were treated with operation and internal “T” model plate fixation, 25 cases in 75 cases were treated with operation and external fixator. Results were evaluated by function after treatment, and percentage of excellence was compared with three different fixation. Results ALL cases were followed up for 6-18 months. The excellence rate of function: external fixator group was 88.0%, “T”model plate group was 91.3% and 44.4% for the plaster group. There were no significant quality difference between external fixator and “T” model plate fixation group, but both were significantly better than the external plaster fixation group. Conclusion For unstable distal radius fractues, external fixator is simple, safe, minimally invasive and clinically effective.
[Key words] Distal radius fracture; External fixator; Internal fixation; Plaster fixation
桡骨远端骨折是临床最常见的骨折之一，其发生率约占急诊骨折的20%左右[1]，以老年女性多见，治疗不当易引起畸形愈合、创伤性关节炎，从而严重影响手的功能，尤其以不稳定性骨折对腕关节功能的远期影响大。目前治疗方法主要有手法复位加石膏托固定及小夹板固定、外固定支架固定、切开复位钢板内固定。本院2006年1月～2011年6月运用手法复位加石膏托固定、外固定支架固定及切开复位“T”型钢板内固定治疗桡骨远端不稳定骨折75例，比较三种固定方法的疗效结果如下：
1资料与方法
1.1一般资料
75例桡骨远端骨折中，男27例，女48例，年龄11～93岁，平均59.5岁，均为新鲜闭合性骨折。治伤原因主要为跌倒伤及击打伤。骨折类型按骨折分类系统AO分型：A3型20例；B型37例，其中B2型15例，B3型22例；C型18例，其中C1型9例，C2型6例，C3型3例。
1.2分组
随机将患者分为石膏托固定组、外固定支架组、钢板内固定组；另有不愿意接受指定治疗方法而作调整(5例)。3组患者的年龄、性别及骨折类型差异均无统计学意义(P > 0.05)，见表1。
1.3治疗方法
1.3.1手法复位 局部麻醉或臂丛神经阻滞下行手法闭合复位 ......
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