手法复位夹板外固定与切开复位克氏针内固定治疗儿童尺桡骨远端双骨折的对比研究

目的:比较手法复位夹板外固定与切开复位克氏针内固定治疗儿童尺桡骨远端双骨折的疗效。方法:选取2013年11月-2015年9月期间我院治疗的闭合性无神经损伤的尺桡骨远端双骨折80例儿童作为研究对象。按治疗方法分为观察组和对照组。观察组40例,对照组40例。观察组给予改良成角折顶手法复位夹板外固定治疗,对照组给予切开复位克氏针内固定治疗。治疗1年后采用VAS疼痛评分、掌倾角、尺偏角、Gartland-Werley功能评分、Anderson功能评定标准评价两组患者的临床疗效和并发症。结果:患儿均达骨性愈合。治疗后1年两组患者VAS评分(1.18±0.71)分,(1.02±0.66)分,t=0.977,P=0.331],掌倾角(6.18°±1.82°,6.63°±1.85°,t=1.096,P=0.277),尺偏角(17.65°±2.80°,18.23°±2.51°,t=0.968,P=0.336)、Gartland-Werley功能评分(2.25±0.63)分,(2.40±0.74)分,t=0.973,P=0.334)],组间差异均无统计学意义(P0.05)。按照Anderson功能评定标准评价疗效,观察组组优28例、良5例、可5例,差2例;对照组优30例、良5例、可4例,差1例;两组患者临床疗效比较,差异无统计学意义(P0.05)。治疗组出现3例并发症,对照组出现6例并发症;两组并发症发生率比较,差异无统计学意义(P0.05)。结论:手法复位夹板外固定与切开复位克氏针内固定治疗儿童尺桡骨远端双骨折,均能缓解疼痛、恢复腕关节功能,改善腕关节活动度,然而手法治疗,创伤小,操作简便,治疗费用低,值得临床应用和推广。

Comparative Study of Manipulative Reduction Splint External Fixation and Open Reduction and Kirschner Wire Fixation for Treatment of Distal Radius Fractures in Children

Objective:Comparison of manipulative reduction splint external fixation and open reduction and Kirschner wire fixation for the treatment of distal radius fractures in children.Methods:Methods 80 cases of closed fractures of the distal radius and ulna were treated in our hospital from November 2013 to September 2015.The patients were divided into observation group and control group.There were 40 cases in the observation group and the other in the control group (n =40).Patients in the observation group were treated with modified angle reduction manipulation and external fixation,while the control group was treated with open reduction and Kirschner wire internal fixation.After 1 years of treatment with VAS pain score,palmar tilt,ulnar deviation,Gartland-Werley score,Anderson function evaluation criteria to evaluate the efficacy and complications of the two groups.Results:All patients achieved bony union.1 years after treatment two groups of patients with VAS score (1.18 ± 0.71) points,(1.02 ± 0.66)points,t =0.977,P =0.331],palmar tilt (6.18° ± 1.82°,6.63° ± 1.85°,t =1.096,P =0.277),ulnar deviation (17.65° ± 2.80°,18.23° ± 2.51°,t=0.968,P=0.336),Gartland-Werley score (2.25 ± 0.63) points,(2.40 ±0.74) points,t =0.973,P =0.334],t =0.973,P =0.334)],the differences between groups were not statistically significant (P ＞ 0.05).According to the evaluation criteria of Anderson function,the observation group was excellent in 28 cases,good in 5 cases,fair in 5 cases and poor in 2 cases.The control group was excellent in 30 all cases,good in 5 cases,fair in 4 cases and poor in 1 cases.Two groups of patients with clinical efficacy,the difference was not statistically significant (P ＞ 0.05).There were 3 cases of complications in the treatment group,and the control group had complications in 6 cases.There was no significant difference in the incidence of complications between the two groups (P ＞ 0.05).Conclusion:Manual reduction splint external fixation and open reduction and Kirschner wire fixation for the treatment of children with double fractures of the distal radius and ulna,can relieve pain,restore wrist function,improve wrist joint activity;However,the treatment of small trauma,simple operation,low cost of treatment,is worthy of clinical application and promotion.