老年桡骨远端骨折治疗方案的选择及疗效比较

摘要

目的 探讨手术与非手术治疗老年桡骨远端骨折的疗效,比较两种治疗方法的影像学结果和患者主观功能评价.方法 将156例老年桡骨远端骨折先行牵引复位、石膏托固定,然后根据复位情况分为非手术治疗组(77例)和手术治疗组(79例).治疗后6个月测量两组患者桡骨远端尺偏角、掌倾角及桡骨远端高度;采用Gartland-Werly评分、DASH评分及VAS评分评价临床疗效.结果 患者均获得随访,时间6~18个月.治疗后6个月时影像学结果:两组均较治疗前明显改善(P<0.05),手术治疗组明显优于非手术治疗组(P<0.05).Gartland-Werly评分优良率:手术治疗组明显优于非手术治疗组(P<0.05).VAS评分及DASH评分:两组比较差异无统计学意义(P>0.05).结论 对于老年桡骨远端骨折患者可先行牵引复位石膏托外固定,然后根据骨折复位及患者综合情况,采取手术或继续非手术治疗,均可获得较好的治疗效果.%Objective To investigate the curative effect of treating distal radium fracture with surgery and non-surgery way,and to compare the imaging results of these two treatment methods and patients′ subjective function evaluation.Methods Traction and reposition was carried out in 156 elderly patients with distal radium fractures,fixed with plaster support.Based on reduction condition,they were divided into non-surgery treatment group (77 cases) and surgery treatment group (79 cases).The distal radius ulnar inclination,palmar tilt and distal radius height of patients from two groups were measured at 6 months after treatment.Clinical curative effect was evaluated by adopting Gartland-Werly score,DASH score and VAS score.Results Patients were all followed up for 6~18 months.Imaging results at 6 months after treatment: both groups were significantly improved,compared with that before treatment (P<0.05),the surgery treatment group was significantly better than that of the non-surgery treatment group (P<0.05).Excellent and good rate of Gartland-Werly score: the surgery treatment group was better than that of the non-surgery treatment group (P<0.05).VAS and DASH score: the difference between two groups had no statistical significance (P>0.05).Conclusions For elderly patients with distal radius fracture,traction,reduction and plaster support fixation can be firstly carried out and then surgery or non-surgery treatment is selected according to fracture reduction and patients′ comprehensive condition.Both treatment methods can obtain good curative effect.