手法整复经皮克氏针结合石膏或夹板固定治疗老年性桡骨远端骨折的病例对照研究

目的:探讨手法整复经皮克氏针合石膏或夹板固定治疗老年性桡骨远端骨折可行性。方法:将2011年6月至2013年5月有住院、门诊复查完整记录的91例桡骨远端新鲜闭合性骨折患者分为3组。A组男20例,女13例,平均年龄(63.27±5.83)岁,采用手法整复单纯石膏或夹板固定术治疗;B组男23例,女12例,平均年龄(64.25±4.53)岁,采用手法整复经皮克氏针结合石膏或夹板固定术治疗;C组男15例,女8例,平均年龄(64.04±4.83)岁,采用开放复位内固定术治疗。采用Dienst评分系统进行临床功能评价和临床影像学评价。结果:随访采用门诊复查的方式,91例均有随访记录,时间10~16个月,平均12个月。采用Dienst评分系统进行临床功能评价:A组优15例,良7例,可11例;B组优25例,良6例,可4例;C组优16例,良5例,可2例。优良率C组高于B组,B组高于A组。正侧位X线片评价:A组可接受26例,不可接受7例;B组可接受28例,不可接受7例;C组可接受19例,不可接受4例;3组间差异无统计学意义。桡骨再移位短缩:A组18例,B组10例,C组6例,C、B组结果优于A组,B组和C组间差异无统计学意义。结论:手法整复经皮克氏针合石膏或夹板固定是治疗老年性桡骨远端骨折有效方法,具有微创、固定可靠、并发症少、外固定无须固定腕关节、可早期功能锻炼等优点。

Clinical research of percutaneous K-wires fixation after manipulative reduction combining with gypsum or splint fixation for treatment of the Barton fractures of aged people

Objective:To investigate the feasibility of using percutaneous K-wires fixation after manipulative reduction combining with gypsum or splint fixation for treatment of the Barton fracture of aged people.Methods:From June 2011 to May 2013,91 patients with closed and fresh Barton fracture were analyzed retrospectively which information was complete. According to different methods these patients were divided into three groups:33 patients in group A were treated by simplex fixation of gypsum or splint after manipulative reduction,including 20 males and 13 females with an average age of(63.27±5.83) years old;35 patients in group B were treated by percutaneous K-wires fixation after manipulative reduction combining with gypsum or splint fixation,including 23 males and 12 females with an average age of (64.25±4.53) years old;23 patients in group C were treated by open reduction and internal fixation including 15 males and 8 females with an average age of(64.04±4.83) years old.Results:All the patients were followed up for 10 to 16 months with an average of 12 months by the method of recheckging in out-patient clinic. According Dienst scoring system:in group A,the result was excellent in 15 cases,good in 7 cases,fair in 11 cases;in group B,excellent in 25 cases,good in 6 cases,fair in 4 cases; in group C,excellent in 16 cases,good in 5 cases,fair in 2 cases. The excellent and good rate of group C was better than that of group B and A,further more group B is better than group A. According to X-ray standard,in group A,26 patients were acceptable,7 patients were un-acceptable; in group B,28 patients were acceptable,7 patients were un-acceptable;in group C,19 patients were acceptable,4 patients were un-acceptable; there were no statistical significant difference(P>0.05). There were 18 patients with emerging re-crispation in group A,10 patients in group B,6 patients in group C,the result of group B and C was better than that of group A,and there was no statistically significant between group B and C(P>0.05).Conclusion:Using percutaneous K-wires fixation after manipulative reduction combining with gypsum or splint fixation for treatment of the Barton fracture of aged people is an effective method,it has advantages of micro-invasived,reliable fixation,less complication,not need to fix wrist joint and early functional exercise.