超肘小夹板与传统小夹板固定治疗粉碎性Colles骨折的病例对照研究

摘要

目的:观察比较超肘小夹板与传统小夹板固定治疗粉碎性Colles骨折的固定效果和临床疗效.方法:2013年10月至2015年10月门诊收治52例粉碎性Colles骨折患者,分传统夹板组和超肘夹板组,超肘夹板组男7例,女19例;年龄38～85岁,平均(64.615±11.475)岁.骨折AO分型:A3型3例,C1型9例,C2型7例,C3型7例.传统夹板组男9例,女17例;年龄36～91岁,平均(65.269±13.162)岁.骨折分型:A3型4例,C1型8例,C2型9例,C3型5例.各组施行手法复位后,传统夹板组以传统前臂小夹板超腕固定,超肘夹板组前3周加用上肢直角板固定肘关节,3周后去除直角板,同传统夹板组固定方法继续固定至骨折愈合.定期复查X线,骨折达临床愈合拆除夹板,并观察X线下桡骨愈合后与复位后相比的短缩长度和掌倾角改变度数.积极功能康复锻炼8周后两组患者参照改良Green和O'Brien临床评分标准进行疗效评分.结果:所有患者骨折临床愈合,并获得随访,平均随访时间8～12周,未发现严重并发症.骨折愈合后桡骨短缩长度:超肘夹板组(2.962±1.248)mm,传统夹板组(5.923±1.978)mm,传统夹板组短缩大于超肘夹板组(P＜0.05).掌倾角改变:超肘夹板组(4.692±2.950)°,传统夹板组为(5.192±3.371)°(P＞0.05).腕关节功能评分:超肘夹板组(89.615±11.482)分,传统夹板组(80.385±13.485)分,超肘夹板组得分高于传统夹板组(P＜0.05).结论:超肘小夹板固定治疗粉碎性Colles骨折比传统前臂四夹板固定效果更可靠,患腕关节功能恢复更优良.%Objective:To analyze the clinical efficacy of over-elbow small splint fixation for the treatment of comminuted Colles fractures.Methods:Fron October 2013 to October 2015,52 patients with comminuted Colles fracture were divided into two groups (the traditional splint fixation group and the over-elbow small splint fixation group) according to the treatment strategy.There were 26 patients in the over-elbow small splint fixation group including 7 males and 19 females with an average age of (64.615± 11.475) years old ranging from 38 to 85 years old,and 26 patients in the traditional splint fixation group including 9 males and 17 females with an average age of (65.269±13.162) years old ranging 36 to 91 years old,respectively.In the overelbow small splint fixation group,3 cases were type A3 fractures,9 cases were type C1,7 cases were type C2 and 7 cases were type C3;in the traditional splint fixation group,4 cases were type A3,8 cases were type C 1,9 cases were type C2 and 5 cases were type C3.After manipulative reduction,the fractures in traditional splint fixation group were fixed with traditional small splint,and the fractures in over-elbow small splint fixation group were added with over-elbow right angle splint for the first three weeks,then continued fixing like the control group until clinical cicatrization.All patients in both groups were regularly taken X-ray examination and changed dressings to obtain the clinical healing.Patients were guided to do functional exercise after splints were taken off.The therapeutic effects were evaluated according to modified Green and O'Brein score system after 8 weeks' functional exercise.Results:All patients got clinical healing without severe complications in both groups.The shortened length of radius in traditional splint fixation group was more than that in over-elbow small splint fixation group (5.923±1.978) mm VS (2.962±1.248) mm (P＜0.05).There was no significant difference in radial incline between two groups.There was a higher wrist score in over-elbow small splint fixation group compared with traditional splint fixation group 89.615±11.482 vs 80.385±13.485 (P＜0.05).Conclusion:Over-elbow small splint fixation is better than traditional splint fixation for the treatment of comminuted Colles fracture because of reliable clinical result and excellent wrist functional recovery.