局麻下手法牵引复位石膏夹板固定治疗桡骨远端骨折250例

目的：观察局麻下手法牵引复位、石膏夹板固定治疗桡骨远端骨折的疗效。方法：2000年1月至2008年3月，采用持续牵引手法复位、伸直尺偏位前后石膏夹板固定治疗250例桡骨远端骨折。骨折愈合后测量腕关节活动度和握力，改良Green和O’Brien临床评分系统评价关节功能。采用腕关节正侧位片测量桡骨长度、桡骨倾斜角、掌倾角、桡尺骨指数及关节间隙宽度。结果：250例中，一次复位成功者209例，41例复位2次。202例腕关节无疼痛，38例偶尔有轻度疼痛，10例中度疼痛。患侧腕关节活动度及握力达到健侧100％者分别为35，72例，达到75％～99％者分别为207，168例，达到健侧50％～70％者分别为8，10例。改良Green和O’Brien评分优178例，良54例，可18例。最终桡骨短缩、桡骨倾斜角、掌倾角、桡尺骨指数明显纠正，与复位前比较，差异有显著性。结论：局麻下手法牵引复位石膏夹板固定是治疗桡骨远端骨折的一种既安全经济有效，又能充分减轻患者痛苦的方法，有利于腕关节功能恢复。

Manual Traction Reduction and Plaster Splintage under Local Anesthesia in the Treatment of Distal Radius Fractures: A Report of 250 Cases

Objective： To observe the therapeutic effects of manual traction reduction and plaster splintage under local anesthesia in treating distal radius fractures. Methods： From January 2000 to March 2008, a total of 250 patients with distal radius fractures were treated by manual reduction under continuous traction and fixation with anteroposterior plaster splints in the position of straight and ulnar leaning. The motive range of wrist and grip force was measured after the union of fracture, and the joint function was as- sessed by Green and O＇ Brien modified scoring system. Radiographs were taken to evaluate the length of radius, tilt angle of radius, palmar tilt angle, ulnar variance and the width of joint. Results： Of 250 patients, 209 received traction reduction just once, 41 received traction reduction for 2 times, and 202 had no wrist pain, 38 had occasionally mild pain, 10 had midrange wrist pain. Respectively, 35 and 72 patients＇ wrist joint activity and grip strength of affected side recovered to 100% of those of healthy side, and 207, 168 patients to 75%~99%, and 8, 10 to 50%-70%. According to Green and O＇ Brien modified scoring system, 178 patients were excellent, 54 good and 18 fair. The length of radius, tilt angle of radius, palmar tilt angle, ulnar variance and the width of joint were corrected obviously. Conclusion： The manual traction reduction and plaster splintage under local anesthesia is a safe, cost-effective treatment for distal radius fractures, it can fully alleviate the sufferings of patients, and it is advantageous to the recovery of wrist joint function.