【摘要】 目的 观察手法复位联合小夹板固定治疗桡骨远端骨折的临床疗效以及对影像学指标的影响。方法回顾性收集江苏省中医优势病种诊疗数据大平台中5家医院的1051例桡骨远端骨折患者的病例资料，根据倾向性评分匹配法按1∶4进行匹配，共纳入580例患者资料，其中中医治疗组（手法复位联合小夹板固定） 448例，手术治疗组（手术切开复位内固定） 132例。每组根据骨折AO分型再分为A、B、C型。比较两组治疗前及治疗后1天、1周、4～6周的影像学指标（掌倾角、尺偏角、桡骨高度），治疗前及治疗后1周、4～6周的疼痛视觉模拟量表（VAS）评分，治疗后12周根据Dienst腕关节功能评分、Gartland与Werley腕关节评分（G-W评分）的腕关节功能等级；再比较不同骨折分型中两组患者上述不同时间的影像学指标，以及治疗后12周腕关节功能等级。结果 两组治疗前后各时间点影像学指标、VAS评分比较差异均无统计学意义，治疗后12周根据Dienst腕关节功能评分和G-W评分的腕关节功能等级比较差异亦无统计学意义（P>0.05）。与本组治疗前比较，两组治疗后1周及治疗后4～6周掌倾角、尺偏角及桡骨高度增加，VAS评分降低（P<0.05）。与本组治疗后1周比较，两组治疗后4～6周掌倾角减小，尺偏角及桡骨高度增加，VAS评分降低（P<0.05）。A、B型骨折中，手术治疗组治疗后4～6周尺偏角高于中医治疗组；C型骨折中，手术治疗组治疗后4～6周桡骨高度高于中医治疗组（P<0.05）。C型骨折中，两组治疗后12周根据G-W评分的腕关节功能等级比较差异具有统计学意义（P<0.05）。结论 手法复位联合小夹板固定治疗桡骨远端骨折能维持骨折形态，减轻疼痛，疗效与手术治疗相当，且尤适用于A、B型骨折，可作为桡骨远端骨折的有效治疗方法。更多还原

【Abstract】 Objective To observe the clinical efficacy and radiographic outcomes of manipulative reduction combined with small splint fixation in the treatment of distal radius fractures. Methods The clinical data of 1051 patients with distal radius fractures were retrospectively collected from five hospitals included in the Jiangsu Diagnosis and Treatment Data Platform for Traditional Chinese Medicine(TCM) Dominant Diseases. Propensity score matching at a 1∶4 ratio was applied, resulting in 580 cases selected for final analysis, which comprised 448 patients in the TCM group(manipulative reduction plus small splint fixation) and 132 in the surgical treatment group(open reduction and internal fixation). Each group was further stratified into type A, B, and C subgroups based on AO fracture classification. Radiographic indicators including palmar tilt, radial inclination, and radial height were compared between groups before treatment and 1 day, 1 week, and 4-6 weeks after treatment, and pain visual analog scale(VAS) scores before treatment and 1 week and 4-6 weeks after treatment were also compared. Wrist joint function was assessed 12 weeks after treatment, using the Dienst wrist function score and the Gartland and Werley(G-W) wrist function score. Additionally, the radiographic indicators at different timepoints and the 12-week wrist function levels were compared between groups across different fracture types. Results No statistically significant difference was observed in radiographic indicators and VAS scores at all timepoints before and after treatment, as well as wrist joint function grades assessed by the Dienst score and the G-W score at 12 weeks after treatment(P>0. 05). Compared to those before treatment, both groups showed increased palmar tilt, radial inclination, and radial height 1 week and 4-6 weeks after treatment, and decreased VAS scores(P<0. 05). Compared to those 1 week after treatment, both groups showed a decrease in palmar tilt, an increase in radial inclination and radial height, and a reduction in VAS score 4-6 weeks after treatment(P<0. 05). In type A and B subgroups, the surgical treatment group had a higher radial inclination than the TCM group 4-6 weeks after treatment, while in the type C subgroup, a higher radial height was shown in the surgical treatment group than in the TCM group 4-6 weeks after treatment(P<0. 05). In type C subgroup, there was significant difference between groups in the wrist joint function by G-W scores 12 weeks after treatment(P<0. 05). Conclusion Manipulative reduction combined with small splint fixation can maintain fracture alignment and alleviate pain in treating distal radius fractures, which achieves therapeutic outcomes comparable to surgical treatment. It is particularly suitable for type A and B fractures and can be considered an effective treatment option for distal radius fractures.更多还原