不同治疗方式对粉碎性柯雷氏骨折两个解剖角的影响

摘要

目的：观察锁定钢板内固定术、手法复位后外固定架固定或高分子夹板固定维持粉碎性柯雷氏骨折（Colles骨折）掌倾角及尺偏角的情况。方法：搜集64例（72侧）分别行锁定钢板内固定术、手法复位后外固定架或高分子夹板固定的粉碎性Colles骨折患者的相关资料进行，其中锁定钢板组16例（22侧），外固定架固定组18例（18侧），高分子夹板组30例（32侧），定期摄片测其掌倾角、尺偏角，以其差值进行比较分析；根据PRWE评分对腕关节疼痛及功能恢复情况进行评价。结果：锁定钢板组掌倾角差值为1.63±0.81，外固定组掌倾角差值为3.68±0.97，高分子夹板组掌倾角差值为4.78±1.41，统计学检验各组在维持掌倾角上差异有统计学意义。锁定钢板组尺倾角差值为0.56±0.23，外固定组尺倾角差值为2.52±0.85，高分子夹板组尺倾角差值为3.01±0.91，统计学检验各组在维持掌倾角上差异有统计学意义。在功能恢复上，锁定钢板组功能恢复优良率为86.4%，外固定组功能恢复优良率为72.2%，高分子夹板组优良率为75.0%，统计学检验三组之间差异无统计学意义。结论：与手法复位后外固定架或高分子夹板固定相比，锁定钢板内固定在维持复位后两个解剖角方面具有一定的优势，但功能恢复没有明显优势。%Objective To observe the outcome of three methods in treating comminuted Colles fracture by locking plate for internal fixation, closed manual external reduction with external fixator or orthopedic splint in maintaining the fracture 's palmar tilt and ulnar inclination. Methods Sixty four cases (72 sides) of outpa⁃tients and emergency or admitted patients by three methods including locking plate for internal fixation, closed manual external reduction with external fixator or orthopedic splint for treatment of comminuted colles fracture were collected, in which containing 16 cases (22 sides) of using locking plate , 18 cases (18 sides) of making use of external fixator, and 30 cases (32 sides) of using plaster immobilization. In regular follow-up, using X ray photography, and PRWE (Patient- Rated Wrist Evaluation) score of Wrist joint to evaluate the conditions of pa⁃tients’pain and functional recovery. Results The Palmar tilt’s difference of the group of locking plate for in⁃ternal fixation was 1.63 ± 0.81, and the palmar tilt’s difference of the group of closed manual external reduction with external fixator was 3.68±0.97. The palmar tilt’s difference of the group of orthopedic splint was 4.78±1.41;statistical tests showed difference between groups in maintaining palmar tilt were significant. The ulnar inclina⁃tion’s difference of the group of locking plate for internal fixation was 0.56±0.23, and the ulnar inclination’s dif⁃ference of the group of closed manual external reduction with external fixator was 2.52±0.85, and the ulnar incli⁃nation’s difference of the group of orthopedic splint was 3.01 ± 0.91, statistical tests showed differences between groups in maintaining ulnar inclination were significant. In terms of functional resoration, the excellent and good rate difference between the group of locking plate for internal fixation was 86.4%, and that between the group of closed manual external reduction with external fixator was 72.2% , the group of orthopedic splint was 75.0%, statistical tests showed the difference be⁃tween groups were not significant. Conclusion Compared with closed manual external reduction with external fixator or orthopedic splint, locking plate internal fixation in the aspect of maintaining the two angles of anatomical reduction shows some advantages of clinical reference value, but no obvious advantage in terms of re⁃covery of function.