三柱理论在Colles骨折手法复位、小夹板固定及早期康复功能锻炼中的指导作用

目的：探讨“三柱理论”在Colles骨折手法复位、小夹板固定及早期功能锻炼中的指导作用,并通过生物力学原理进行定性分析。方法：自2011年8月至2012年2月,在桡骨远端“三柱理论”指导下,采用手法复位、小夹板固定及早期指导功能锻炼治疗47例Colles骨折患者,其中男21例,女26例;年龄40-76岁,平均（65.5±2.3）岁。桡骨远端骨折AO分型：A型27例,其中A2型18例,A3型9例;C型20例,其中C1型10例,C2型6例,C3型4例。术后观察记录疼痛和肿胀恢复时间及术后并发症情况,术后12周采用Gartland-Werley评分系统对腕关节功能进行系统评价,并进行生物力学定性分析。结果：47例患者均获随访,时间3-9个月,平均5个月。术后自觉疼痛缓解时间5-15 d,平均（7.6±2.2）d;手背肿胀消退时间6-13 d,平均（8.9±1.9）d,在治疗过程中有2例患者3 d内出现张力性水泡,无其他并发症发生。术后12周Gartland-Werley评分,优25例,良18例,中4例。结论：Colles骨折在桡骨远端“三柱理论”指导下进行手法复位、小夹板固定及早期功能锻炼,可减缓疼痛和肿胀时间,促进骨折愈合,有效恢复腕关节功能,临床疗效确切,具有合理的生物力学理念。

Guiding role of three-column theory in manipulative reduction, small splint fixation and early rehabilitative exercises for Colles fracture

Objective: To explore guiding role of three-column theory in manipulative reduction,small splint fixation and early rehabilitative exercises of Colles fracture. Methods: From August 2011 to February 2012,47 patients with Colles fractures were treated by manipulative reduction small splinting fixation and early rehabilitative exercises under the guidance of three-column theory,including 21 males and 26 females aged from 40 to 76 years old with an average of (65.5±2.3). According to AO fracture classification,27 patients were type A(including 18 cases with type A2 and 9 cases with type A3) and 20 patients were type C(including 10 cases with type C1,6 cases with type C2 and 4 cases with type C3). Pain and recovery time of swelling,postoperative complications were observed and recorded,Gartland-Werley scoring system were applied for evaluate functional recovery and biomechanical analysis of wrist joint at 12 weeks after operation. Results: All patients were followed up for 3 to 9 months with average of 5 months. Pain relief time ranged from 5 to 15 d with average of(7.6 ± 2.2) d,recovery time of swelling of opisthenar was for 6 to 13 d with an average of (8.9 ± 1.9) d. Two patients occurred tension vesicle within 3 days after operation,but no other complications occurred. According to Gartland-Werley scoring system,25 cases got excellent results,18 cases good and 4 cases moderate at 12 weeks after operation. Conclusion: Under the guidance of three-column theory,treating Colles fracture by manipulative reduction,small splinting fixation and early rehabilitative exercises can reduce pain and swelling time,promote union of fracture,effectively rehabilitate wrist function,improve clinical efficacy,and fit for concept of biomechanics.