可塑性夹板治疗桡骨远端骨折的生物力学机理及临床疗效评价研究

发布时间：2018-05-09 03:44

本文选题：可塑性夹板 + 桡骨远端骨折　；参考：《上海交通大学》2015年硕士论文

【摘要】：目的观察可塑性夹板治疗桡骨远端骨折的压力分布,评价可塑性夹板治疗桡骨远端骨折的临床疗效。方法基础研究方面:选取6具新鲜尸体上肢标本,模拟A2型桡骨远端骨折造模,利用SPI Tactilus 32通道压力传感器分别测试可塑性夹板及石膏外固定下,骨折断端周围桡侧、背侧、掌侧压力分布情况。临床研究方面:选取72例桡骨远端骨折患者,根据AO分型,按照时间顺序随机分为两组,治疗组采用可塑性夹板中立位固定,对照组采用管型石膏中立位外固定,固定周期均为6周,观察周期均为3个月。各组分别于固定后即刻、固定后2周、固定6周后行腕关节正侧位X片,运用PACS系统分析测量固定后即刻及固定6周后X线片桡骨高、尺偏角、掌倾角,分析比较两组上述三项影像学差异;按照改良Green和O’Brien腕关节评分标准,分别于固定6周及3个月后对患腕关节功能进行评价。结果基础研究方面:可塑性夹板外固定能对骨折断端周围桡侧、掌侧、背侧提供略小于石膏外固定所产生的压力,但两者之间无明显统计学差异(P0.05)。临床研究方面:可塑性夹板与传统石膏外固定均能较好的维持桡骨远端骨折复位后及固定6周后的桡骨高、尺偏角、掌倾角,且两者之间比较无明显差异(P0.05);根据改良Green和O’Brien腕关节评分标准,外固定6周时可塑性夹板与石膏外固定在改善腕关节功能状况、活动范围、疼痛、握力及临床方面作用类似(P0.05),但治疗3月后可塑性夹板外固定在改善腕关节功能状况、活动范围及临床疗效方面优于石膏外固定(P0.05)。结论可塑性夹板亦能够对骨折断端提供一定的压力维持骨折断端的稳定性;可塑性夹板治疗A2、B型桡骨远端骨折中期临床疗效优于石膏外固定,值得进一步研究。
[Abstract]:Objective to observe the pressure distribution of distal radius fracture treated with plastic splint and to evaluate the clinical effect of plastic splint on distal radius fracture. Methods basic research: six fresh cadaveric upper limb specimens were selected to model the distal radius fracture of type A2, and the plastic splint and plaster external fixation were used to test the radial and dorsal sides of the fracture with SPI Tactilus 32 channel pressure sensor, respectively. Distribution of palmar pressure. Clinical study: 72 patients with distal radius fracture were randomly divided into two groups according to AO classification. The treatment group was treated with plastic splint neutral position and the control group was treated with plaster neutral position external fixation. The fixed period was 6 weeks and the observation period was 3 months. The radiographs of the wrist were taken immediately after fixation, 2 weeks after fixation and 6 weeks after fixation. The height of radius, the angle of ulnar deviation, and the angle of palm inclination were measured by PACS system analysis immediately after fixation and 6 weeks after fixation. The function of the affected wrist was evaluated after 6 weeks and 3 months of fixation according to the modified Green and O'Brien wrist scoring standards. Results in basic research, plastic splint external fixation could provide slightly less pressure on radial side, palmar side and dorsal side of fracture than that produced by plaster external fixation, but there was no significant difference between them (P 0.05). In clinical study, plastic splint and traditional plaster external fixation can maintain the radial height, ulnar deviation angle, palmar inclination angle after reduction of distal radius fracture and 6 weeks after fixation. According to the modified Green and O'Brien wrist scoring standards, plastic splint and plaster external fixation at 6 weeks of external fixation could improve wrist function, range of movement and pain. Grip strength and clinical effect were similar to that of P0.05, but plastic splint external fixation after 3 months was better than plaster external fixation in improving the function of wrist joint, range of movement and clinical effect. Conclusion plastic splint can also provide a certain pressure to maintain the stability of fracture end, and the effect of plastic splint is better than that of plaster external fixation in the treatment of distal radius fracture of type A _ 2 and B, which is worthy of further study.
【学位授予单位】：上海交通大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R683

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