【摘要】 目的比较手法复位石膏外固定和掌侧钢板内固定治疗桡骨远端骨折的疗效。方法根据患者骨折程度及手术意愿,40例桡骨远端骨折患者采用手法复位石膏外固定治疗(为非手术组),32例桡骨远端骨折患者采用掌侧钢板内固定治疗(为手术组)。治疗后摄X线片复查骨折复位情况,记录治疗1年后腕关节活动度。末次随访时,采用Gartland-Werley评分评价腕关节功能,采用腕关节功能自主评定表(PRWE)评价患者满意度。结果患者均获得随访,时间12～24个月。两组治疗后摄X线片复查显示,骨折均对位良好,尺偏角、掌倾角、桡骨高度手术组均优于非手术组(P <0.05)。骨折均愈合,时间3～6(3.9±1.5)个月。治疗后12个月腕关节、前臂活动度各项指标两组比较差异均无统计学意义(P> 0.05)。末次随访时,两组腕关节功能优良率比较差异有统计学意义(P <0.05);两组患者满意率比较差异无统计学意义(P> 0.05)。结论切开复位掌侧钢板内固定治疗不稳定型桡骨远端骨折的功能优于手法复位石膏外固定,但由于手法复位石膏外固定方法简单、患者痛苦少、费用低,故仍可作为稳定或相对稳定型桡骨远端骨折的首选治疗方法。更多还原

【Abstract】 Objective To compare the therapeutic effects of manual reduction and plaster external fixation and volar plate internal fixation for treatment of distal radius fracture. Methods Depending on the extent of the fracture and the patient’s operative willingness,40 cases who suffered from distal radius fractures were treated with manual reduction and plaster external fixation( non-operation group),and 32 cases of distal radius fractures were treated with volar plate internal fixation( operation group). After treatment,the X-ray film examination was used to review the situation of fracture reduction,and the range of motion( ROM) of wrist was recorded at 1 year postoperation. At the last follow-up,Gartland-Werley scoring system was used to assess the wrist function,and Patient-Rated Wrist Evaluation( PRWE)was used to evaluate the patient’s satisfaction. Results All the patients were followed up for 12 ～ 24 months. The reexamination of X-ray films in the two groups showed that the fractures were good alignment. The ulnar deviation angle,palmar inclination angle and radial height of the operation group were better than those of the non-operation group( P < 0. 05). All the fractures healed within 3 ～ 6( 3. 9 ± 1. 5) months. At 12 months after treatment,there were no significant differences in the various indicators of the ROM of wrist joint and forearm between the two groups( P >0. 05). At the last follow-up,there was significant difference in the excellent-good rate of wrist function between the two groups( P < 0. 05); there was no significant difference in the satisfactory rate between the two groups( P > 0. 05).Conclusions Open reduction and volar plate internal fixation is better than conservative manual reduction and plaster external fixation for treatment of instability distal radius fracture,while the later are simpler,less pain,and lower cost,which are the first therapeutic method for stable or relatively stable distal radius fracture.更多还原