摘要
目的比较手术与非手术治疗老年桡骨远端不稳定骨折的疗效。方法将64例老年桡骨远端不稳定骨折患者按照治疗方法不同分为非手术组(受伤当日采用手法复位石膏外固定治疗,40例)和手术组(采用切开复位锁定钢板内固定治疗,24例)。记录两组骨折复位及愈合情况、影像学指标、腕关节活动度及术后并发症发生情况。采用上肢功能调查量表(DASH)评价腕关节功能恢复情况。结果患者均获得随访,非手术组随访时间12~16(13.4±2.4)个月,手术组随访时间13~17(14.1±1.8)个月。①骨折复位及愈合情况:非手术组石膏外固定当日解剖复位13例,功能复位27例;骨折均愈合,时间4~6周。手术组均解剖复位;骨折均愈合,时间4~8周。②掌倾角、尺偏角、桡骨高度:治疗后12周、12个月手术组明显优于非手术组(P<0.05)。③腕关节活动度及DASH评分:治疗后12个月两组比较差异均无统计学意义(P>0.05)。④治疗后并发症发生情况:非手术组1例发生反射性交感神经性骨营养不良。手术组2例切口浅表感染。结论手法复位石膏外固定治疗老年桡骨远端不稳定骨折方法简单,患者无需住院,而且能有效恢复腕关节功能,尤其对于高龄患者是一种良好的选择。
Objective To compare the effect of operation and non-operation for unstable distal radius fracture in elderly patients.Methods The 64 cases of unstable distal radius fracture in the elderly were suffered from the distal radius fractures, they were divided into the non-operation group(40 cases) and operation group(24 cases).The non-operation group was performed with closed manipulative reduction and plaster external fixation on the day of injury, and the operation group was adopted with open reduction and internal fixation with locking compression plate.Fracture reduction and healing situation, radiographic indicators, the range of motion(ROM) of the wrist joint, incidence of complications after surgery were recorded.The wrist function recovery was assessed with disability of arm, shoulder and hand(DASH) scores.Results All patients were followed up, the non-operation group was followed up for 12~16(13.4±2.4) months, the operation group was followed up for 13~17(14.1±1.8) months.① Fracture reduction and healing situation: in the non-operation group, there were 13 cases of anatomic reduction and 27 cases of functional reduction on the day of plaster fixation, all patients healed within 4~6 weeks.All patients were anatomically reduced and healed in the operation group;the healing time was 4~8 weeks.②Volar angulation, radical inclination, radial height: the operation group was better than the non-operation group at 12 weeks, 12 months after treatment(P<0.05).③ ROM of the wrist joint and DASH scores: there were no significant differences at 12 months after treatment(P>0.05).④ Incidence of complications after treatment: there was a case of reflex sympathetic bone dystrophy in the non-operation group, and 2 cases of incision superficial infection in the operation group.Conclusions It is simple that manipulative reduction and plaster external fixation are used to treat unstable fractures of the distal radius in the elderly, which does not require hospitalization, and can effectively restore wrist joint function,
作者
李怀木
陈嘉良
方玮
韩雪昆
LI Huai-mu;CHEN Jia-liang;FANG Wei;HAN Xue-kun(Dept of Orthopaedics,Nanjing Meishan Hospital,Nanjing,Jiangsu 210039,China)
出处
《临床骨科杂志》
2022年第2期228-232,共5页
Journal of Clinical Orthopaedics
