梁辉

[摘要] 目的 探讨手法复位后采用改良的腕功能位固定治疗伸直型桡骨远端粉碎性骨折的疗效并与传统夹板固定进行比较。 方法 选择2008年2月～2013年1月160例伸直型桡骨远端粉碎性骨折患者，随机分为实验组（I）及对照组（Ⅱ）。实验组采用腕功能位石膏托外固定3周，3周后改为夹板外固定；而对照组应用传统夹板掌屈尺偏位固定，两组均固定至临床愈合，观察其临床疗效。 结果 160例患者均获随访，随访时间10～45个月，平均28个月；根据X线和腕关节功能评估，实验组优良率达96.3%，对照组80.0%；两组临床疗效及影像学比较差异有统计学意义（P <0.05）。结论 改良的腕功能位外固定治疗伸直型桡骨远端粉碎性骨折较传统夹板方法为好。

[关键词] 伸直型；桡骨远端粉碎性骨折；改良外固定；腕功能位

[中图分类号] R687.3 [文献标识码] B [文章编号] 1673-9701（2014）11-0149-03

[Abstract] Objective To treat extension type distal radius comminuted fractures by improved function wrists position fixation after manipulative reduction，and compared with the traditional splint. Methods A total of 160 patients with distal radial comminuted fracture were divided into two groups from February 2008 to January 2013，patients in groupⅠreceived treatment of function wrists position fixation with plaster fixation， after 3 weeks， plaster external fixation was changed with splint external fixation on wrist function position；patients in groupⅡreceived treatment of traditional volar tilt and ulnar deviation angle with splint external fixation，the clinical effect was compared after Clinical healing.Results All the patients were followed up for 10 to 45 months， mean 28 months；The fracture all healed on clinical.Accordingto Denist functional evaluation system and regularly X-ray after manipulative reduction， the good-excellent rate of groupⅠwas 96.3%，and was 80.0% of groupⅡ. The effective rate was significantly superior to that of group I，there are Significance in Statistics on clinical effect and Imaging Assessment between two groups（P <0.05）. Conclusion The outcome of improved wrists position of function fixation is better than that of traditional splint on the function and radiology for treating extension type distal radius comminuted fractures.

[Key words] Extension type；Distal radius comminuted fractures；Improved external fixation；Functional wrists position

笔者自2008年2月～2013年1月对160例伸直型桡骨远端粉碎性骨折闭合手法复位后采用改良的腕功能位外固定处理，取得较好疗效。报道如下。

1 资料与方法

1.1一般资料

2008年2月～2013年1月共收治桡骨远端粉碎性骨折患者160例，男64例，女96例，年龄36～88岁，平均63.5岁。受伤至就诊时间为0.5 h～2 d，平均0.5 d。受伤原因：交通意外伤40例，跌倒96例，坠落伤24例。均为新鲜骨折。依据AO/ASIF对骨折类型进行分类，90例为C2型，70例为C3型。

1.2 病例选择

诊断标准参照实用骨科学[1]，分型根据X线片按桡骨远端骨折的AO分类法分型。纳入标准：符合以上诊断标准，同意接受以手法复位、改良腕关节功能位外固定治疗，并能按医嘱定期复诊至临床愈合，配合功能锻炼及接受随访及疗效评价。排除标准：不符合诊断及纳入标准；开放性骨折；……