手法复位后小夹板外固定治疗高龄Barton骨折临床研究

目的 评价手法复位后小夹板外固定治疗高龄Barton骨折疗效.方法 将符合纳入标准的244例高龄Barton骨折患者按随机数字表法分为保守组126例和手术组118例.保守组采用手法复位小夹板外固定治疗,手术组采用切开复位钢板内固定治疗,观察患者术后并发症情况,记录患者骨折愈合时间、住院时间、治疗费用,采用患者腕关节自我评价问卷(patient-rated wrist evaluation,PRWE)及Wrightington腕关节功能评分系统评价腕关节功能,采用Gartland-Werley Colles骨折疗效评定方法评价临床疗效.结果 保守组优良率为91.3%(115/126)、手术组优良率为97.5%(115/118),2组比较差异无统计学意义(χ2=0.857,P=0.354).治疗后1年、6个月、3个月、6周,保守组PRWE评分(10.4±7.9)分、(19.1±8.0)分、(40.5±7.8)分、(55.7±8.1)分比(80.8±8.2)分,F=113.665]、Wrightington评分(8.2±3.7)分、(13.2±4.0)分、(21.4±3.9)分、(26.3±4.2)分比(30.1±4.2)分,F=121.348]均低于同组治疗前(P<0.01);手术组PRWE评分(10.2±7.8)分、(15.0±8.0)分、(26.5±8.0)分、(44.7±8.2)分比(79.6±8.6)分,F=81.411]、Wrightington评分(8.1±3.8)分、(12.1±4.0)分、(16.5±4.0)分、(20.6±4.3)分比(29.8±4.6)分,F=69.113]均低于同组治疗前(P<0.01).治疗后1年2组PRWE评分及Wrightington评分比较,差异均无统计学意义(t值分别为0.149、0.104,P值>0.05).保守组住院时间(5.28±2.10)d比(12.25±2.21)d,t=25.260]短于手术组(P<0.01),治疗费用(3.26±0.93)千元比(28.66±1.04)千元,t=200.369]低于手术组(P<0.01).保守组并发症总发生率为8.7%(11/126)、手术组为17.8%(21/118),2组比较差异有统计学意义(χ2=4.396,P=0.036).结论 2种治疗方式治疗高龄Barton骨折均可获满意疗效,与保守治疗相比,切开复位钢板内固定早期疗效优势明显,但手法复位小夹板外固定具有方法简单、费用低、创伤小、住院时间短、并发症少等优势.

Clinical study of the manual reduction with small splint external fixation for the elderly Bratons fracture

Objective Evaluation of the effect of manual reduction with small external fixation on the treatment of elderly Barton fractures.Methods A total of 244 elderly patients with Barton fractures were divided into conservative group (n=126) and operation group (n=118) according to random number table. The conservative group was treated by with manual reduction with small external fixation, and the operation group was treated with open reduction and internal fixation. The complications of the patients, the time of fracture healing, hospitalization time and treatment cost were recorded.The wrist function was evaluated by PRWE wrist score system and Wrightington wrist function score system.The clinical efficacy was evaluated by Gartland-Werley Colles fracture evaluation method.Results The excellent and good effect rate was 91.3% (115/126) in the conservative group and 97.5% (115/118) in the operation group. There was no significant difference between the two groups(χ2=0.857,P=0.354). One year, 6 months, 3 months and 6 weeks after treatment, in the conservative group, the PRWE score (10.4 ± 7.9, 19.1 ± 8.0, 40.5 ± 7.8, 55.7 ± 8.1vs. 80.8 ± 8.2,F=113.665), wrightington score (8.2 ± 3.7, 13.2 ± 4.0, 21.4 ± 3.9, 26.3 ± 4.2vs. 30.1 ± 4.2,F=121.348) were significantly lower than those before treatment (P<0.01). And in the operation group, the PRWE score (10.2 ± 7.8, 15.0 ± 8.0, 26.5 ± 8.0, 44.7 ± 8.2vs. 79.6 ± 8.6,F=81.411), Wrightington score (8.1 ± 3.8, 12.1 ± 4.0, 16.5 ± 4.0, 20.6 ± 4.3vs. 29.8 ± 4.6,F=69.113) were significantly lower than those before treatment (P<0.01). But there was no significant difference in PRWE score and Wrightington scores between the two groups after treatment (t=0.149, 0.104,P=0.881, 0.917, respectively). In the conservative group, the hospitalization time (5.28 ± 2.10 dvs. 12.8 ± 2.21d,t=25.260) was significantly shorter than that of the control group (P<0.01), and the treatment cost (3.26 ± 0.93 thousandvs. 28.66 ± 1.04 thousand,t=200.369) was significantly lower than that in the control group (P<0.01). The overall incidence of complication was 8.7% (11/126) in the conservative group and 17.8% in the surgery group (21/118). There was significant difference between the two groups(χ2=4.396,P=0.036).Conclusions The manual reduction with small splint external fixation was simple, low cost, small trauma, short hospitalization time, and less complications.