田兵 蔣乙兵 楊波 黃三廷 帥奇 王宏

摘 要：目的 對比手法整復(fù)小夾板固定與石膏外固定治療橈骨遠(yuǎn)端骨折的臨床療效。方法 選擇2015年9月～2017年9月我院骨科收治的橈骨遠(yuǎn)端骨折患者60例，隨機(jī)分成小夾板組與石膏外固定組，各30例。所有患者采用手法整復(fù)，小夾板組應(yīng)用小夾板固定，石膏外固定組采用石膏固定，觀察兩組患者患肢掌傾角、尺偏角和橈骨高度及腕關(guān)節(jié)功能情況。結(jié)果 60例患者均獲得隨訪，隨訪時間6～24個月。末次隨訪X線片顯示，小夾板組患者掌傾角、尺偏角和橈骨高度恢復(fù)情況均優(yōu)于石膏外固定組患者，組間比較，差異具有統(tǒng)計學(xué)意義（P<0.05）；小夾板組患者手術(shù)優(yōu)良率93.33%，高于石膏外固定組的76.66%，差異具有統(tǒng)計學(xué)意義（P<0.05）。結(jié)論 手法整復(fù)小夾板固定治療橈骨遠(yuǎn)端骨折較石膏外固定臨床療效好更優(yōu)，小夾板復(fù)位丟失發(fā)生情況低于石膏外固定，腫脹消退、骨折愈合后功能優(yōu)于石膏固定。

關(guān)鍵詞：橈骨遠(yuǎn)端骨折；手法整復(fù)；小夾板固定；石膏外固定

中圖分類號：R683.7 文獻(xiàn)標(biāo)識碼：A DOI：10.3969/j.issn.1006-1959.2018.14.035

文章編號：1006-1959（2018）14-0118-02

Abstract：Objective To compare the clinical effect of manual reduction splint fixation and plaster external fixation in the treatment of distal radius fracture.Methods From September 2015 to September 2017，60 patients with distal radius fracture were randomly divided into splint group and plaster external fixation group，30 cases each.All patients were treated by manual reduction，splint group was fixed with small splint and plaster fixation was used in the plaster external fixation group.The palmar angle of the limbs，the angle of ulnar，the height of the radius and the function of the wrist were observed in the two groups.Results All 60 patients were followed up for 6 to 24 months.The last follow-up X-ray showed that the degree of palm tilt，ulnar deviation and tibia height recovery in the splint group were better than those in the external plastering group，the difference was statistically significant（P<0.05）.The excellent and good rate of operation in the small splint group was 93.33%，which was higher than that in the external plastering group 76.66%，the difference was statistically significant（P<0.05）.Conclusion The treatment of distal radius fracture by manual reduction and splint fixation is better than that of plaster external fixation.The incidence of reduction and loss of small splint is lower than that of plaster external fixation，and the swelling subsides，and the function after fracture healing is better than that of plaster fixation.

Key words：Distal fracture of radius

橈骨遠(yuǎn)端骨折（distal fracture of radius）是臨床上比較常見的骨折，損傷發(fā)生率約占臨床所見骨折的17%[1]。在中老年人群中，女性患者明顯多于男性，隨著年齡的增加，其發(fā)生率逐步上升，低能量損傷遠(yuǎn)超高能量損傷發(fā)生率，其發(fā)生多與高齡、絕經(jīng)后骨質(zhì)疏松密切相關(guān)。腕關(guān)節(jié)功能活動要求較高，橈骨遠(yuǎn)端骨折失治、誤治易導(dǎo)致腕關(guān)節(jié)慢性疼痛、創(chuàng)傷性關(guān)節(jié)炎與關(guān)節(jié)僵硬，嚴(yán)重者將影響腕、手部功能。我院骨科對比2015年9月～2017年9月采用手法整復(fù)小夾板外固定與石膏外固定治療橈骨遠(yuǎn)端骨折療效，為臨床上選擇提供依據(jù)，現(xiàn)報告如下。

1 資料與方法

1.1一般資料 選擇2015年9月～2017年9月銅仁市中醫(yī)院骨傷科60例橈骨遠(yuǎn)端骨折患者的資料，所有骨折均為新鮮骨折，受傷至治療時間均小于3 d且為閉合損傷。采用數(shù)字隨機(jī)分配原則將其分為小夾板固定組和石膏外固定組各30例。其中小夾板固定組男13例，女17例，年齡30～76歲，平均年齡（54.91±13.12）歲，骨折AO分型：A型16例，B型11例，C型3例。石膏外固定組男11例，女19例，年齡29～74歲，平均年齡（56.3±12.9）歲，骨折AO分型：A型17例，B型9例，C型4例。兩組患者性別、年齡、骨折AO分型等資料比較，差異無統(tǒng)計學(xué)意義（P>0.05），臨床可比。