小夹板与石膏外固定治疗老年C型Colles骨折对照研究

目的比较闭合手法整复夹板与石膏外固定治疗老年C型Colles骨折的临床疗效。方法将96例老年C型Colles骨折患者随机分为治疗组和对照组,各48例。2组闭合手法整复后,治疗组予小夹板外固定,对照组予管形石膏外固定。测量整复前、整复后当天和拆除固定时(第6周)X线桡骨长度、掌倾角及尺偏角变化,观察2组的解剖位置丢失情况。拆除固定后6个月,根据Gartland-Werley腕关节功能评分法进行关节功能评价。结果 2组整复后当天、拆除固定时与整复前比较,桡骨长度、掌倾角及尺偏角均有明显改善,差异有统计学意义(P0.05)。拆除固定时与整复后当天比较,桡骨长度、掌倾角及尺偏角均有不同程度丢失(P0.05),对照组丢失程度更为明显(P0.05)。拆除固定后6个月治疗组腕关节功能优9例,良26例,可6例,差4例,优良率为77.8%(35/45);对照组中优4例,良22例,可10例,差9例,优良率为57.8%(26/45)。治疗组疗效优于对照组(P0.05)。结论闭合手法整复夹板外固定治疗老年C型Colles骨折比管形石膏固定疗效显著。

Case-control Study on Small Splint and Plaster External Fixation after Closed Manipulative Reduction in the Treatment of Elderly Type C Colles Fractures

Objective To compare the clinical effects of small splint fixation after closed manipulative reduction with plaster external fixation in the treatment of elderly type C Colles fractures.Methods Totally 96 elderly patients with type C Colles fractures were randomly divided into two groups, 48 patients in each group. Both groups were treated with closed manipulative reduction. The fractures were externally fixed with splint in the treatment group, and those were externally fixed with pipe plaster in the control group. The figure of radius length, palmar tilt and ulnar deviation were detected respectively in pre-reduction, the same day with reduction, and the day when external fixation was removed （6th week）, in order to evaluated the drop of anatomical position. The therapeutic effects were evaluated according to Gartland-Werley wrist score when external fixation was taken off after 6 months.Results In both groups, figures of radius length, palmar tilt and ulnar deviation evidently increased in the day after reduction and the day of external fixation removal, compared with pre-reduction （P〈0.05）. Compared with the day after reduction, the radius length, palmar tilt and ulnar deviation of the day of external fixation removal all dropped in both groups （P〈0.05）. But the drop degree in control group was significantly higher than treatment group （P〈0.05）. For the joint function, 9 cases for excellent, 26 for good, 6 for fair, and 4 for bad in the therapy group. The excellent and good rate was 77.8% （35/45）. In the control group, 4 cases for excellent, 22 for good, 10 for fair and 9 for bad. The excellent and good rate was 57.8% （26/45）. The curative effect of treatment group was remarkably superior to control group （P〈0.05）.Conclusion Closed manipulative reduction combined with splint external fixation is more effective than pipe plaster in treatment of elderly type C Colles fractures.