Analysis in effects of three therapies in treatment of unstable distal radius fracture
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摘要:目的 比较手法复位石膏固定、闭合复位外固定架固定辅以克氏针简易固定、切开复位桡骨远端解剖锁定钢板固定3种方法治疗桡骨远端不稳定型骨折的疗效。方法 选取81例桡骨远端不稳定型骨折（根据AO分型，均为C3型骨折）患者作为研究对象，采用随机数字表法分为3组，每组27例。手法复位组采用手法复位石膏固定法治疗，闭合复位组采用闭合复位外固定架固定辅以克氏针简易固定法治疗，切开复位组采用切开复位桡骨远端解剖锁定钢板固定法治疗，观察并比较3组患者的疗效。结果 闭合复位组的术后再移位率低于另外2组，切开复位组的术后再移位率低于手法复位组，差异均有统计学意义（P < 0.05）。应用Cooney腕关节评分标准评价患者术后功能，闭合复位组、切开复位组、手法复位组的优良率分别为88.89%、77.78%、51.85%，差异有统计学意义（P < 0.05）。结论 闭合复位外固定架固定辅以克氏针简易固定法操作简单，创伤小，能持续有效地维持骨折端稳定，患者术后腕关节功能恢复良好，治疗费用低，是治疗桡骨远端不稳定型骨折的理想方案，疗效明显优于手法复位石膏固定法和切开复位桡骨远端解剖锁定钢板固定法。Abstract:Objective To compare curative effects of technique reduction and plaster fixation, closed reduction and external fixation by external fixator as well as simple fixation by Kirschner wire, open reduction of distal radius anatomy locking plate fixation type in treatment of unstable distal radius fracture.Methods A total of 81 patients with unstable fractures of distal radius(according to the AO classification, they were all C3 type fractures) were selected as study objects, and they were divided into three groups by random number table method, with 27 cases in each group. The manual reduction group was treated with manual reduction and plaster fixation, closed reduction group was treated by closed reduction and external fixation by external fixator as well as simple fixation by Kirschner wire, and open reduction group was given open reduction and anatomical locking plate fixation of the distal radius. The curative effect of three groups was observed and compared.Results The redisplacement rate after operation in the closed reduction group was significantly lower that that in the other two groups, and was significantly lower in the open reduction group than that of manual reduction group(P < 0.05). According to Cooney wrist scoring standard, the excellent and good rates in the manual reduction group, the closed reduction group, and the open reduction group were 51.85%, 88.89%, and 77.78%, respectively, and significant differences were found in three groups(P < 0.05).Conclusion The closed reduction and external fixation combined with simple fixation by Kirschner wire in the treatment of unstable distal radius fractures is significantly better than the manual reduction as well as plaster fixation and open reduction as well as open reduction of distal radius anatomy locking plate fixation. The operation is simple in operation, has less trauma and cost, and the fracture stability is maintained continuously and effectively after operation. Therefore, it is an ideal method for the treatment of unstable fractures of the distal radius.
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Keywords:
- unstable distal radius fracture /
- closed reduction /
- open reduction /
- manual reduction /
- fixation /
- re-shifting
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表 1 3组患者术后再移位情况比较[n(%)]
组别 n 无移位 轻度移位 重度移位 总移位 手法复位组 27 4(14.81) 12(44.44) 11(40.74) 23(85.19) 闭合复位组 27 24(88.89) 3(11.11) 0 3(11.11)*# 切开复位组 27 20(74.07) 5(18.52) 2(7.41) 7(25.93)* 与手法复位组比较, *P < 0.05; 与切开复位组比较, #P < 0.05。 
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表 2 3组患者疗效比较[n(%)]
组别 n 优 良 中 差 总优良 手法复位组 27 6(22.22) 8(29.63) 8(29.63) 5(18.52) 14(51.85) 闭合复位组 27 18(66.67) 6(22.22) 2(7.41) 1(3.70) 24(88.89)*# 切开复位组 27 10(37.04) 11(40.74) 4(14.81) 2(7.41) 21(77.78)* 与手法复位组比较, *P < 0.05; 与切开复位组比较, #P < 0.05。
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