李小红 彭长辉 黄敏章 周小兰

【摘要】 目的：觀察桡骨远端骨折患者分别采用传统手法复位石膏外固定与手术内固定治疗的效果。方法：选取2017年1月-2018年7月笔者所在医院骨科收治的79例桡骨远端骨折患者作为研究对象，根据治疗方案的不同将其分为研究组（49例）和对照组（30例）。研究组采用传统手法复位+石膏外固定制动治疗，对照组采用切开复位内固定手术治疗。比较两组治疗后6周，3、6个月疼痛程度、骨折复位效果及腕关节功能优良率。结果：两组治疗后6周、3个月时复位效果评分比较，差异均有统计学意义（P<0.05），但两组治疗后6个月复位效果评分比较，差异无统计学意义（P>0.05）。治疗前两组VAS评分比较差异无统计学意义（P>0.05）;治疗后6周、3、6个月两组VAS评分比较差异均无统计学意义（P>0.05）。治疗后6周、3个月两组Gartland and Werley腕关节功能评分优良率比较，差异均无统计学意义（P>0.05），治疗后6个月，研究组Gartland and Werley腕关节功能评分优良率为98.0%，明显高于对照组的86.7%，差异有统计学意义（P<0.05）。结论：对于桡骨远端骨折患者，采用传统手法复位+石膏外固定制动治疗，治疗后6周、3个月时复位效果更好，但治疗后6个月的复位效果与切开复位内固定手术治疗相当，治疗后6个月腕关节功能恢复更好，值得推广。

【关键词】 桡骨远端骨折 传统手法复位 石膏外固定 内固定手术

[Abstract] Objective： To observe the clinical effects of traditional manual reduction and plaster external fixation and surgical internal fixation for distal radius fracture patients. Method： A total of 79 patients with distal radius fracture admitted in the Orthopedic department of our hospital from January 2017 to July 2018 were selected as the study objects. According to different treatment schemes， they were divided into the study group （49 cases） and the control group （30 cases）. The study group was treated with traditional manual reduction and plaster external fixation， while the control group was treated with surgical internal fixation. The degree of pain， the reduction effect of fracture and the excellent and good rate of wrist joint function were compared between the two groups at 6 weeks， 3 and 6 months after treatment. Result： There were a significant difference in the reduction effect scores between the two groups at 6 weeks and 3 months after treatment （P<0.05）. There was no significant difference in the reduction effect scores between the two groups at 6 months after treatment （P>0.05）. There was no significant difference in VAS score between the two groups before treatment （P>0.05）. There were no significant differences in VAS scores between the two groups at 6 weeks， 3 months and 6 months after treatment （P>0.05）. There was no significant difference in the excellent and good rates of Gartland and Werley wrist function scores between the two groups at 6 weeks and 3 months after treatment （P>0.05）. At 6 months after treatment， the excellent and good rate of Gartland and Werley wrist function scores of the study group was 98.0%， which was significantly higher than 86.7% of the control group， the difference was statistically significant （P<0.05）. Conclusion： For the patients with distal radius fracture， the reduction effect is better at 6 weeks and 3 months after the treatment by traditional manual reduction and plaster external fixation， but the reduction effect at 6 months after the treatment is equivalent to that of surgical internal fixation， and the wrist joint function recovery is better at 6 months after treatment， which is worth popularizing.

桡骨远端骨折是临床上较常见的骨折之一，是指发生在桡骨远端2 cm以内的干骺端骨折，常累及下尺桡关节及桡腕关节[1]。桡骨远端骨折的临床发病率高，具有较高的残疾率[2]。手术是临床治疗桡骨远端骨折最直接有效的方法，在受伤后及时就诊，积极采取有效的处理措施可获得良好的预后[3-4]。本文就保守治疗、手术治疗对桡骨远端骨折的效果进行对比研究，旨在寻找更适合桡骨远端骨折患者的治疗方法，为临床提供借鉴经验，现将内容总结如下。