严重桡骨远端骨折的治疗

目的:探讨严重桡骨远端骨折治疗方法及临床疗效。方法:47例桡骨远端骨折,男20例,女27例;年龄45~89岁,平均67岁。按AO原则分类,根据不同的骨折类型,采用不同的治疗方法。21例(A组)采用闭合复位石膏或夹板外固定,其中A31例,B12例,B23例,B33例,C112例。8例(B组)采用闭合整复,多功能支架外固定(包括配合经皮克氏针固定),A31例,B22例,C11例,C22例,C32例。6例(C组)采用切开复位T形或斜T形钢板螺钉内固定,其中B11例,B22例,C12例,C21例。12例(D组)切开复位钢板内固定配合多功能支架外固定,B12例,B22例,B33例,C13例,C21例,C31例。结果:按Shea评定法评估,A组(非手术组)优8例,良6例,中5例,差2例,优良率为66·7%(14/21);B组优6例,良1例,中1例,优良率87·5%(7/8);C组优4例,良1例,中1例;D组优8例,良2例,中2例,C、D两组优良率均为83·3%(5/6,10/12)。结论:严重桡骨远端骨折,根据AO分类的不同,手术治疗比非手术治疗有明显的优势,具体方法可根据骨折的类型不同进行选择。

Treatment of severe distal radius fracture

Objective:To explore therapeutic method and clinical effect of severe distal radialis fracture.Methods:Forty-seven distal radial fractures(20 males and 27 females,aged from 45 to 89 years with an average of 67 years)were treated with different methods according to different classification of fracture.Among the patients,21 cases underwent close reduction and splinting(group A;A_3,B_1,B_2,B_3,C_1 were 1,2,3,3,12 respectively),8 cases underwent close reduction and multiple-power external fixation (group B;A_3,B_2,C_1,C_2,C_3 were 1,2,1,2,2 respectively),6 cases underwent open reduction and T-shape steel plate fixation (group C;B_1,B_2,C_1,C_2 were 1,2,2,1 respectively),12 cases undenwent open reduction and multiple-power external fixation(group D;B_1,B_2,B_3,C_1,C_2,C_3 were 2,2,3,3,1,1 respectively).Results:According to the criterion of Shea, 8 cases obtained excellent result,6 good,5 fair,2 poor,the rate of excellent and good was 66.7% (14/21) in group A.Six cases obtained excellent result,1 good,1 fair,the rate of excellent and good was 87.5% (7/8) in group B.In group C and D,the excellent,good,fair result were,4,1,1 and 8,2,2 respectively,the rate of excellent and good was 83.3%(5/6,10/12).Conclusion:Operative treatmemt for severe distal radial fracture has the advantage over non-operative.Operative methods can be selected according to fracture type.