手法复位联合夹板外固定治疗老年桡骨远端骨折的临床疗效观察

目的 探讨手法复位联合夹板外固定治疗老年桡骨远端骨折的临床疗效.方法 回顾性分析自2019-01-2020-01采用手法复位联合夹板外固定治疗的46例老年桡骨远端骨折,根据术前X线片与骨折端的具体移位情况给予适当的手法复位,待骨折端位置矫正满意后,用4块小夹板及3根绷带条对患肢进行外固定,最后应用吊带将患肢悬挂于胸前,...     

活血酊外敷联合手法复位夹板外固定治疗老年桡骨远端骨折疗效分析

目的:研究活血酊外敷联合手法复位夹板外固定治疗老年桡骨远端骨折的临床效果。方法:选取我院骨伤科2016年1月—12月所收治的92例老年桡骨远端骨折患者,按随机数字表法分为研究组和对照组,每组各46例。对照组用单纯中医手法复位夹板外固定,研究组在对照组治疗基础上加用我院自制剂活血酊外敷。随访6~12个月,比较两组患者的临床疗效并评分。结果:研究组骨折愈合时间较对照组时间明显缩短,差异有统计学意义(P<0.05),研究组与对照组腕关节功能恢复优良率分别为91.3%和78.3%。研究组疗效优于对照组,差异有统计学意义(P<0.05)。结论:活血酊外敷联合手法复位夹板固定在桡骨远端骨折患者临床治疗中,具有骨折愈合时间短,功能恢复好等优势,值得临床推广应用。     

小夹板结合石膏外固定治疗桡骨远端骨折

目的探讨对桡骨远端骨折患者实施小夹板结合石膏外固定治疗的临床价值。方法选取伊川县中医院2014-01—2017-01间收治的76例桡骨远端骨折患者,按照不同外固定方法分为2组,每组38例。手法复位后予以对照组小夹板固定治疗,对观察组行小夹板结合石膏外固定治疗。比较2组疗效。结果观察组患者术后2周内疼痛评分低于对照组,骨折愈合时间短于对照组,差异均有统计学意义(P0.05)。随访12个月,末次随访观察患者腕关节功能评分高于对照组,差异有统计学意义(P0.05)。结论小夹板结合石膏外固定在桡骨远端骨折患者的临床治疗中,具有固定牢靠、疼痛轻、骨折愈合快,腕关节功能恢复效果好等优点。     

手法整复小夹板外固定治疗桡骨远端骨折的临床观察

<正>桡骨远端骨折系临床常见的损伤,多因跌倒后手部触地所致,成年人及老年人多表现为粉碎性骨折,在儿童则表现为桡骨远端骨骺分离或不完全骨折。常表现有明显的移位及短缩畸形,其中向背侧移位的为伸直型、向掌侧移位的为屈曲型。在临床上采用传统的整复手法和小夹板加压垫外固定     

小夹板结合3D打印支具外固定治疗Colles骨折

目的:探讨手法复位小夹板配合3D打印腕关节支具外固定治疗Colles骨折的近期临床疗效,以及支具的使用优势。方法:选取2017年2月至12月在中山市中医院就诊的Colles骨折患者,符合纳入标准的共60例。所有患者分为两组,即对照组和试验组。对照组30例,男13例,女17例;年龄16～66(49.46±12.63)岁;损伤至就诊时间3～18 (6.86±3.15) h。试验组30例,男12例,女18例;年龄14～68(46.73±14.40)岁;损伤至就诊时间3～19 (7.06±3.45) h。试验组及对照组患者均由同一医师手法整复骨折,X线片显示复位满意后予以小夹板外固定。待骨折整复后1周起,试验组拆除小夹板,更换3D打印支具维持固定至骨折愈合;对照组维持小夹板固定直至骨折愈合后拆除。两组患者分别在整复前后、复位后4周摄腕关节X线片,观察掌倾角、尺偏角、桡骨高度并比较;同时记录复位前后,复位1、2周后两组患者VAS评分、肿胀程度评分;复位6～8周解除外固定后比较两组腕关节Cooney及患者腕关节自我评价评分(patient rated wrist evaluation,PRWE)评分。结果:复位2周VAS评分试验组2.40±0.49,对照组2.43±0.50,两组比较差异无统计学意义(P=0.364);肿胀程度评分试验组0.50±0.50,对照组0.53±0.50,两组比较差异无统计学意义(P=0.746)。复位6～8周后试验组Cooney及PRWE评分优于对照组(P0.05),掌倾角、尺偏角、桡骨短缩等解剖学特征方面试验组优于对照组(P0.05)。结论:3D打印支具轻巧透气、舒适美观、方便敷药,结合小夹板分时段应用于Colles骨折临床疗效确切,丰富了外固定治疗的方法。     

小夹板结合石膏外固定治疗桡骨远端骨折的疗效分析

目的探讨桡骨远端骨折手法复位成功后外固定方式的合理选择和优缺点。方法将局麻下手法复位成功的182例Colles骨折随机分为2组:夹板组92例全程应用中医小夹板外固定,综合组90例石膏外固定1~2周后改为中医小夹板外固定。结果夹板组早期1~2周内疼痛明显,VAS评分为(6.7±1.3)分,严重影响功能练习;综合组石膏外固定组1~2周内疼痛不明显,VAS评分为(3.8±1.5)分,患者耐受度较高,差异有统计学意义(P<0.01)。6~8周骨折愈合去除外固定后,夹板组Cooney评分优良率为80.43%,综合组优良率为93.33%,差异有统计学意义(P<0.05)。结论石膏结合夹板外固定对手法复位成功后骨折固定可靠,对急性期肿胀疼痛和后期功能锻炼有良好的分时段、分阶梯治疗效果。     

手法整复小夹板外固定治疗儿童尺桡骨远端骨折

<正>儿童尺桡骨远端双骨折是儿童常见骨折之一,尺桡骨完全骨折后,骨折端常发生旋转、成角或背向重叠移位,尤其背向重叠移位在临床上尤为多见[1],其治疗难点,一是复位困难;二是复位后易重新移位;三是儿童骨骺尚未闭合,尽量不考虑手术治疗。若处理不当,可引起腕关节及前臂的功能受限。2009年急诊科采用手法复位小夹板外固定治疗儿童尺桡骨远端骨折29例,现总结报告如下。     

手法复位小夹板外固定治疗C型老年桡骨 远端骨折的前瞻性随机对照临床试验

目的 探讨手法复位小夹板固定治疗C型老年桡骨远端骨折的可行性及临床应用价值.方法 采用单中心对照试验,观测时间为18月,其中小夹板、石膏管型外固定组干预1个月,随访17个月;外固定架组干预6~8周,LCP组(锁定加压钢板)和外固定架组随访18个月.对来自2007年1月至2010年3月新疆维吾尔自治区中医医院创伤骨科门诊及病房的328例AO分类属C型的老年桡骨远端骨折患者,根据是否愿意接受手术治疗分为保守组192例和手术组136例.再采用随机区组的方法随机分为小夹板外固定96例,石膏管型外固定96例;LCP组68例,外固定架组68例.运用改良Green与O'Brien评分进行疼痛、功能、活动度、握力的评价;影像学方面采用Stewart与改良的Sanniento评分方法对桡骨高度短缩、尺偏角、掌倾角进行对比.结果 随访3个月时,四组之间腕关节功能评价具有统计学意义(P＜0.05),其中小夹板组比石膏固定组功能优越(P＜0.05);LCP组与外固定架组功能相当(P＞0.05);LCP组与外固定架组比小夹板组与石膏组功能优越(P＜0.05).随访18个月时,四组之间腕关节功能差异无统计学意义(P＞0.05).3个月时影像学比较四组之间有统计学意义(P＜0.05),其中小夹板与石膏固定在3个月时桡骨高度短缩、尺偏角减小、掌倾角减小方面无统计学意义(P＞0.05),LCP与外固定架组间有统计学意义(P＜0.05).小夹板与LCP组、小夹板与外固定架组间有统计学意义(P＜0.05),石膏与LCP组、石膏与外固定架组之间有统计学意义(P＜0.05).结论 老年C型桡骨远端骨折短期内手术治疗比非手术治疗在腕关节功能恢复及影像学方面有优势,一年后功能状态相差不大.     

手法整复夹板固定治疗桡骨上1/3斜形骨折

本院经多年临床摸索 ,根据桡骨上 1/ 3斜形骨折以背向背旋转移位为主的特点 ,运用旋转回绕为主手法整复、小夹板固定结合中药内服外敷 ,自 1993～ 1999年 ,治疗该类病人 16例 ,总结如下。1　临床资料本组共 16例 ,均为新鲜闭合性桡骨上 1/ 3斜形单骨折 ,男 11例 ,女 5例 ;年龄 7～ 6 2岁 ;骨折端移位特点均为背向背旋转移位 ,需行手法整复。2　治疗方法2 1　整复手法　患者坐位 ,患肩外展、肘屈 ,前臂中立位 ,两助手对抗牵引 ,先加重牵引力 ,使骨折段分开 ,嵌入的软组织自行解脱 ,然后放松牵引 ,在患者筋肉松驰的情况下 ,术者两手分别握住…     

Open reduction and internal locked fixation of unstable distal ulna fractures with concomitant distal radius fracture

PURPOSE: To evaluate the results following locking plate fixation of unstable distal ulna fractures with concomitant distal radius fracture. METHODS: A retrospective review was conducted to identify patients who had been treated with a locking plate for unstable displaced fractures of the distal ulna in which a concomitant ipsilateral distal radius fracture was also treated operatively. Medical records and radiographs were reviewed, and 5 patients were identified with an average age of 52 years (range, 47-61 years) and with follow-up averaging 11.6 months (range, 6-17 months). There were 2 open and 3 closed fractures. Included was 1 simple neck, 1 comminuted neck, 1 head, and 2 head and neck fractures of the distal ulna. All distal radius fracture implants were locked volar plates. RESULTS: All distal ulna and distal radius fractures united, and the average motion was: flexion 59 degrees ; extension 59 degrees ; pronation 67 degrees ; and supination 72 degrees . Average grip strength was 97% of the opposite extremity. Final ulnar variance averaged -0.4 mm (ulnar negative), radial inclination was 20 degrees , and volar tilt was 8 degrees . All distal radioulnar joints were stable. Two patients had mild, transient paresthesias of the dorsal sensory branch of the ulnar nerve, and both patients recovered completely within 3 months. There were no subsequent surgeries or hardware failures. There were no infections and no wound problems. Based upon the Sarmiento modification of the Gartland and Werley rating score, there were 4 excellent results and 1 good result. CONCLUSIONS: Locked plating of unstable distal ulna fractures, in the setting of an associated distal radius fracture, resulted in union, good to excellent alignment and motion, nearly symmetric grip strength, and minimal transient morbidity.     

指套牵引联合手法复位外固定治疗老年桡骨远端骨折的临床效果

目的 对比指套牵引联合手法复位外固定与单纯手法复位外固定治疗老年桡骨远端骨折的临床疗效。方法:选取2022年3月—2023年3月于天津大学天津医院就诊的老年桡骨远端骨折患者1000例,以随机数字表法均分为指套牵引联合手法复位组和单纯手法复位组。在手法复位后2天、1周、2周、4周、8周、12周及20周对两组患者的腕关节活动度、疼痛、Gartland-Werley腕关节评分进行比较。结果:排除脱落病例后,指套牵引联合手法复位组纳入487例,手法复位组491例。相比于单纯手法复位,指套牵引联合手法复位显著提升了背伸(P=0.024)、尺偏(P<0.001)、掌屈(P=0.003)活动度,降低了复位8周(P<0.001)、12周(P=0.022)、20周(P=0.002)时患者的Gartland-Werley腕功能评分,但没有显著抑制随访期中患者的主观疼痛。结论:指套牵引联合手法复位外固定可部分地提高老年桡骨远端骨折患者复位后腕关节的活动度及功能。     

Common myths and evidence in the management of distal radius fractures

Distal radius fractures (DRFs) are the most common fracture treated by physicians, but questions remain regarding optimal management. Fracture patterns, biomechanics, and treatment strategies have been debated for more than 200 years, and research shows many controversies regarding long-held beliefs. Although these common myths have been propagated and considered fact, they are not based on the best-available evidence. This article illustrates some of the major controversies regarding the management of DRFs. To provide optimal care in a world of evidence-based medicine, clinicians must shift their thinking and accept that some of the indoctrinated ideas may represent a flawed heuristic approach.     

掌侧2．4mm锁定钢板治疗复杂桡骨远端关节内骨折

目的：探讨掌侧2.4 mm锁定钢板治疗复杂桡骨远端关节内骨折的使用方法和疗效。方法从2010年2月至2013年2月本组对新鲜桡骨远端关节内骨折,在伤后两周内使用掌侧2.4 mm锁定加压钢板（或称锁定钢板）进行切开复位内固定手术。随访的病例共48例,男20例,女28例。 AO分型：C1型10例,C2型14例,C3型24例。结果在掌倾角、尺偏角,桡骨相对长度与3.5 mm组相比无统计学差异,而关节面平整程度则2.4 mm组优于3.5 mm组,统计学差异有意义。关节的屈伸（96.3°±12.6°）、旋转活动（97.6°±13.8°）;握力结果（72.3±10.6） kg。静息时疼痛分级与3.5 mm组比较无统计学差异。活动时疼痛分级及DASH评分2.4 mm组优于3.5 mm组,统计学差异有意义。最终所有骨折均愈合,有3例发生并发症。结论掌侧2.4 mm锁定钢板治疗复杂桡骨远端关节内骨折能有更好的复位质量,从而减少了患者术后活动时的疼痛。并使功能恢复更理想。     

外固定器结合克氏针固定治疗桡骨远端不稳定型骨折

[目的]总结桡骨远端不稳定骨折外固定器结合克氏针固定的手术技巧和疗效。[方法]自2002年10月～2004年6月，48例均采用外固定架结合克氏针骨折端交叉固定，早期功能康复。随访时间6～24个月。[结果]按改良的Mcbride评分标准，远期疗效优良者44例，优良率91．6％。[结论]强调克氏针交叉固定桡骨远端骨折结合外固定器固定，提高了骨折的稳定性，腕关节可中立位固定，避免过度牵引，可早期功能康复，功能评价优于单纯应用外固定器。     

Size and stabilization of the dorsoulnar fragment in AO C3-type distal radius fractures

IntroductionVolar locking plate (VLP) fixation has become the gold-standard treatment for distal radius fractures (DRFs). Especially, internal fixation of the volar lunate facet fragment is essential for the treatment of AO C3-type DRFs. On the other hand, the necessity of the fixation of the dorsal lunate facet fragment (dorsoulnar fragment) remains unclear. The purpose of the present study was to measure three-dimensionally the size of the dorsoulnar fragments in AO C3-type DRFs using computed tomography (CT) images in detail, and to reveal relationships of the size and stabilization of the dorsoulnar fragment with postoperative fracture displacement after VLP fixation.Materials and methodsWe retrospectively reviewed the 101 consecutive Japanese patients who underwent surgical treatment for AO C3-type distal radius fractures. If patient had dorsoulnar fragment, the three-dimensional size of this fragment and the occupying ratio to the radiocarpal joint (RCJ) and the distal radioulnar joint (DRUJ) were anatomically evaluated using the preoperative CT images. In addition, we investigated the relationship of the size and stabilization of the dorsoulnar fragment with fracture displacement after VLP fixation. We statistically compared the size parameters and occupying ratio of the dorsoulnar fragment between the displaced group and the stable groups using a two-tailed t-test. We also statistically compared the numbers of screws inserted into the dorsoulnar fragments between the displaced and stable groups using a chi-square test.ResultsThe mean dorsoulnar fragment size was 9.4 mm × 7.9 mm × 11.0 mm and the occupying ratio to the DRUJ and RCJ was 50% and 10%, respectively. The number of patients treated with volar locking plate fixation was 77, of which 12 patients had postoperative displacements. Although the size of the dorsoulnar fragment was not associated with postoperative displacement, stabilization following screw insertion into the dorsoulnar fragment was significantly associated with displacement.ConclusionStabilization of the dorsoulnar fragment with at least one screw of the volar locking plate was necessary to prevent postoperative fracture displacement regardless of dorsoulnar fragment size in AO C3-type distal radius fractures.     

桡骨远端关节内简单骨折非手术与切开复位内固定治疗的比较

目的比较桡骨远端关节内简单骨折采用闭合复位石膏外固定(CRPF)和切开复位内固定(ORIF)治疗的疗效。方法回顾性分析自2011-10—2013-10采用闭合复位石膏外固定及切开复位内固定治疗56例桡骨远端关节内简单骨折的临床资料。对以下指标进行比较:腕关节活动度、影像学测量数值、腕关节患者自行评估(Patient-Rated Wrist Evaluation,PRWE)评分、并发症和再手术情况。结果所有骨折均愈合,ORIF组平均愈合时间稍长。CRPF组有2例因合并关节下粉碎性骨折导致复位不理想改行切开复位内固定治疗。CRPF组有个别患者的桡骨高度、掌倾角有丢失,但2组的PRWE评分、影像学及功能结果、并发症情况差异无统计学意义(P0.05)。结论 2种方法对于单纯桡骨远端关节内简单骨折的远期效果均良好,但合并关节面下粉碎性骨折的患者,ORIF的疗效更佳。     

The importance of pronator quadratus repair in the treatment of distal radius fractures with volar plating

Background

Open reduction internal fixation (ORIF) of distal radius fractures via a volar approach involves surgical release of the overlying pronator quadratus (PQ) muscle. Complete repair of the PQ, defined as full and stable replacement of the periphery of the PQ back to its original anatomic location, is not always possible upon conclusion of the operation. Postoperative consequences of incomplete PQ repair with regards to range of motion (ROM), grip strength, and complications are not well documented. It was hypothesized that the completeness of PQ repair would yield no significant difference in the postoperative ROM, grip strength, and incidence of complications.

Methods

A retrospective review was performed of 110 repairs of distal radius fractures with ORIF via placement of a volar locking plate. The following clinical data were extracted: complete or incomplete PQ repair, patient age, gender, follow-up ROM/grip strength, and incidence of postoperative complications.

Results and conclusions

No significant difference in ROM, grip strength, and postoperative complications was detected between the complete and incomplete PQ repair groups. Complications consisted of two incidences of malunion requiring revision surgery and one occurrence of complex regional pain syndrome. There were no tendon ruptures. No statistical difference in ROM/grip strength or incidence of postoperative complications was detected between the complete and incomplete PQ repair groups. Regardless of the level of injury sustained by the PQ, surgeons should make an effort to cover the distal aspect of the volar plate during closure following distal radius fracture ORIF. Coverage of the distal aspect of the plate with the PQ (at a minimum) provides adequate results in ROM and grip strength, as well as protection against flexor tendon injury.

Level of evidence

Therapeutic Level III: Retrospective Comparative Study.     

两种治疗方案对老年人桡骨远端骨折的疗效比较

目的:探讨采用保守治疗和切开复位内固定两种方案对65岁以上老年人桡骨远端骨折(DRF)的疗效。方法:选择我院于2020年6月—2022年2月收治的DRF患者81例,依据随机数法分为手法组(46例)与切开组(35例)。手法组采用骨折手法复位高分子聚酯绷带固定治疗;切开组采用切开复位内固定手术治疗。使用X线片对比患者治疗前后的尺偏角、掌偏角和桡骨高度,以评估治疗情况。统计患者末次随访的改良Mayo腕关节评分(MMWS)、DASH-Chinese上肢功能评分以及并发症,对患者预后评价。结果:两组治疗后尺偏角、掌偏角和桡骨高度较治疗前增加(P<0.05);切开组治疗后尺偏角、掌偏角和桡骨高度高于手法组(P<0.05)。两组治疗后MMWS较治疗前增加,而DASH-Chinese上肢功能评分较治疗前降低(P<0.05);切开组治疗后MMWS高于手法组,而DASH-Chinese上肢功能评分低于手法组(P<0.05)。切开组并发症发生率低于手法组(P<0.05)。结论:切开复位内固定术治疗老年人DRF有明显的临床优势,可以促进患者腕关节和上肢功能恢复。