邓雄伟 洪静 李润香 胡和军

[摘要] 目的 探讨新型医用握力器配合中药熏洗在老年桡骨远端C3型骨折手术后的临床疗效。 方法 选择2017年1月～2019年1月在我科收治老年桡骨远端C3型骨折住院患者，共90例，均为新鲜损伤。分为常规组、握力器组和中药熏洗组，所有病例行切开复位内固定术，常规组患者术后每日进行掌指关节、指间关节屈伸自行功能锻炼，握力器组在常规组基础上给予医用多弹簧握力器锻炼，中药熏洗组应用上肢熏洗方，熏洗结束后给予医用多弹簧握力器锻炼，评价指标：分析治疗后掌倾角、尺偏角及桡骨高度，并进行比较;利用电子握力测量器对双侧握力进行测量，并进行记录比较;参照Dienst腕关节功能标准进行评估。 结果 90例患者均获随访，平均10个月，术后无切口感染、皮肤坏死等并发症。骨折均愈合良好，平均3个月。6个月随访时，掌倾角、尺偏角、桡骨高度与术后即刻相比差異无统计学意义（P>0.05）;三组患者术后6个月握力较术后2周均有明显改善，差异有统计学意义（P<0.05），握力恢复依次是中药熏洗组、握力器组、常规组，三组患者采用Dienst腕关节功能标准进行评定，恢复效果依次是中药熏洗组、握力器组、常规组。 结论 老年C3型桡骨远端骨折行切开复位锁定钢板固定手术后，采用中药熏洗配合新型医用多弹簧握力器能很好恢复握力和关节功能，具有很好的临床效果。骨科医生除了关注桡骨远端骨折手术后关节功能恢复外，也应该重视握力恢复这个理念。

[关键词] 老年;桡骨远端骨折;握力器;中药熏洗

[中图分类号] R687.3          [文献标识码] B          [文章编号] 1673-9701（2020）17-0116-04

Clinical application of a new type of medical hand grips combined with fumigation and washing of traditional Chinese medicine in elderly patients with C3 distal radius fracture after operation

DENG Xiongwei   HONG Jing   LI Runxiang   HU Hejun

Department of Orthopedics and Traumatology， Division Ⅷ， Hongdu Hospital of TCM Affiliated to Jiangxi University of Traditional Chinese Medicine， Nanchang   330000， China

[Abstract] Objective To explore the clinical efficacy of a new type of medical hand grips combined with fumigation and washing of traditional Chinese medicine（TCM） in elderly patients with C3 distal radius fracture after operation. Methods From January 2017 to January 2019， 90 elderly patients with newly incurred C3 distal radius fracture were admitted to and hospitalized in our department. They were divided into the routine group， the hand grips group and the fumigation and washing of TCM group. With all of these patients undergoing open reduction and internal fixation（ORIF）， after operation the patients in the routine group performed flexion and extension function training of metacarpophalangeal joints and interphalangeal joints by themselves every day; the hand grips group was permitted medical multi-spring hand grips exercises on the basis of the routine group; the fumigation and washing of TCM group applied upper limb fumigation and washing therapy and conducted medical multi-spring hand grips exercises after the fumigation and washing ended. The evaluation indexes were as follows： the palm inclination angle， ulnar deflection angle and radius height after treatment were analyzed and compared; the electronic dynamograph was used to measure the gripping strength of both sides which was then recorded and compared; the wrist joint function evaluation standard of Dienst was used for evaluation. Results The 90 patients were followed up for an average of 10 months. There were no postoperative complications such as incision infection and skin necrosis. All fractures healed well with an average of 3 months. During the 6th month follow-up， the palm inclination angle， ulnar deflection angle and radius height were compared with those immediately after surgery， and the differences were not statistically significant（P>0.05）. The gripping strength of the three groups of patients was significantly improved 6 months after operation compared with that 2 weeks after surgery， and the difference was statistically significant（P<0.05）. The gripping strength recovered in the order of the fumigation and washing of TCM group， the hand grips group and the routine group. When assessed by the wrist joint function evaluation standard of Dienst， the three groups of patients had their recovery effect ranked in the order of the fumigation and washing of TCM group， the hand grips group and the routine group. Conclusion After open reduction and locking plate fixation for elderly patients with C3 distal radius fracture， the fumigation and washing of TCM combined with a new type of medical multi-spring hand grips can restore gripping strength and joint function well， so it has good clinical effect. Orthopedic surgeons should not only pay attention to the recovery of joint function after distal radius fracture surgery， but also attach importance to the concept of the recovery of gripping strength.

[Key words] Elderly; Distal radius fracture; Hand grips; Fumigation and washing of traditional Chinese medicine（TCM）

桡骨远端骨折是老年人最常见骨折之一[1]，既往老年桡骨远端骨折多采用手法复位后石膏或夹板固定保守治疗，但对于C3型骨折，保守治疗会出现骨折再移位、创伤性关节炎等并发症，影响关节功能恢复，临床处理较棘手，由于保守治疗效果差，常需手术治疗，恢复关节面平整，术后除了积极进行腕关节功能康复外，对于手指握力恢复也非常重要，临床医生往往对此关注度低。20……