闭合性桡骨远端骨折手法复位小夹板固定临床路径的病例对照研究

目的:探讨以手法复位小夹板固定治疗闭合性桡骨远端骨折在保证临床疗效的基础上,缩短治疗时间,减轻患者医疗费用,创建中医优势病种门诊诊疗的临床路径。方法:自2007年7月至2009年12月,共200例患者,年龄40～80岁,分为提前拆除小夹板组(CP治疗组)和常规治疗组,各100例。CP治疗组男21例,女79例;年龄(62.98±0.85)岁;常规治疗组男20例,女80例;年龄(63.19±0.88)岁。均采用手法复位小夹板固定后,常规治疗组30d拆除小夹板,CP治疗组在第25天拆除小夹板,两组定期摄X线片复查及内服中药(早期口服玄胡片、创伤宁片,中期口服归香正骨丸,后期口服双龙接骨丸)至骨折临床愈合,拆除夹板后指导功能锻炼。患者在治疗中评定复位情况,了解骨位,采用Gartland-Werley腕关节评分标准评估腕关节功能,进行疗效观察。结果:CP治疗组患者的实际治疗时间从原来的(30.08±3.06)d下降到(25.06±1.07)d,治疗费用由(2100.00±332.12)元下降到(1644.00±125.20)元。两组在复位、腕关节功能恢复方面比较差异无统计学意义,说明中医门诊治疗的疗效可以保证。结论:在中医骨科门诊实施临床路径后,促进了诊疗行为的规范化及治疗时间的缩短,为广大病患减轻了医疗经济负担,值得推广应用。

Case-control study on the manipulation reduction combined with small-splint fixation for the treatment of closed fracture of radius

Objective:To explore the clinical effects of the manipulation reduction combined with small splint fixation for the treatment of fresh closed fracture of radius for shorten hospital stays and reduce medical cost. Methods:From July 2007 to December 2009,200 patients( ranged the age from 40 to 80 years) with distal radius comminute fracture were treated and divided into CP group( including 21 males and 79 females,with a mean age of (62.98±0.85)years),and control group( including 20 males and 80 females,with a mean age of(63.19±0.88)years). All patients were treated manipulation reduction combined with small-splint fixation,control group removed small-splint 30 days after treatment,CP group removed 25 days after treatment. Two groups were checked by X-ray and took traditional chinese medicine(taking Yuanhu tablets,Chuangshangning tablets on the early stage;Guixiangzhenggu pill was taken on the middle stage;Shuanglongjiegu pill on the late stage),functional exercise was guided after removing of small splint. The condition of reduction and position of bone were evaluated and Gartland-Werlley scale was used to evaluate the function of wrist joint. Results:Treatment time in CP group was decreased from(30.08±3.06) to (25.06±1.07) days;treatment cost in CP group was decreased from(2 100.00±332.12) to (1 644.00±125.20) Yuan. There was no significant difference in reduction and function recover of wrist joint between two groups. The results showed the effects of TCM clinic can be promised. Conclusion:Clinical pathway for outpatient can promote standardization of outpatient,short treatment time less medical economic burden,and worth widely used.