对桡骨远端粉碎性骨折及关节内骨折患者手术结合中药治疗的疗效评价

目的：评价手术结合中药治疗桡骨远端粉碎性骨折及关节内骨折的方法及疗效。方法：综合分析2000年4月-2003年4月采用不同方法治疗桡骨远端粉碎性骨折及关节内骨折患者的治疗效果。32例患者根据AO原则进行分类，按不同类型骨析相应采用钛板螺钉内固定、简单内固定加外固定架固定及单纯外固定架固定手术治疗，其中7例患者术后加中药外敷。结果：随访了全部患者，功能满意者26例，占81．25％；功能尚可者5例，占15．62％；功能不满意者1例，占3．13％。加敷中药者x线片显示骨折愈合时间及住院时间均显著缩短。结论：经合理的手术方法治疗桡骨远端粉碎性骨折及关节内骨折，能最大限度地恢复桡(尺)骨的相对长度、关节面平整、掌倾角及尺偏角，术后配合合理的锻炼，可以使腕关节功能得到最大恢复，加敷中药有助于骨折的愈合。

Estimation on curative effect of the surgical operation combining traditional Chinese medicine for the comminuted and intra-articular fractures of the distal radius

Objective: To estimate the curative effect of the surgical operation combining traditional Chinese medicine(TCM) for the comminuted and intra-articular fractures of the distal radius. Methods: Thirty-two cases of suffering from the comminuted and intra-articular fractures of the distal radius by different operation method treatment in three years were synthetically analyzed and 7 cases of them were treated with TCM after operation. All cases were sorted according to AO principle. Thirty-two cases were operated upon either with internal fixation with the Titanium screw plane or with simple internal fixation adding external fixator or with simple external fixator according to the types of fracture. Results: All patients were followed-up regularly. According to AO evaluation of the wrist joint movement, 81 25 percent (26 cases ) of the patients had satisfactory functional outcome, 15 62 percent (5 cases) of the patients had quite satisfactory functional outcome and only 3 13 percent (1 case) of the patients had unsatisfactory functional outcome. The time of the fracture concrescence and being in hospital in the patients of applied TCM were significantly shortened by X-ray photo. Conclusion: The reduction of the distal radial fractures should include the maintenance of the relative length of the radius and ulna, the smoothness of the articular surface and the palmar and ulnar deviation angles. The shortening of the radius results in the pain with movement and the restriction of function, and hence is considered to be the most important factor affecting the joint function. The ulnar deviation is quite easy to restore, and its mal-angulation is rare. The reduce palmar deviation angle results in the restriction of the wrist flexion. For the comminuted and intra-articular distal radial fractures, the surgical reduction for the maintenance of the relative length of the radius and ulna, a good reduction of articular surface, reduction of palmar and ulnar deviation angle are the key points for a successful outcome. Early functional exercise is equally important for the best recovery of wrist function. Applying TCM after the operation could help the fracture concrescence.