手法整复改良克氏针内固定术治疗老年桡骨远端不稳定骨折临床研究

发布时间：2018-07-01 12:39

本文选题：桡骨远端骨折 + 不稳定骨折　；参考：《广州中医药大学》2017年硕士论文

【摘要】：目的:通过对比研究手法整复结合改良克氏针内固定术和切开复位钢板螺钉内固定术治疗老年桡骨远端骨折不稳定型骨折的临床疗效,为老年桡骨远端不稳定型骨折治疗方法的选择提供临床依据。方法:选取2015年3月～2016年9月深圳平乐骨伤科医院老年桡骨远端骨折患者60例,随机将患者分为实验组和对照组,每组30例,实验组予手法整复结合改良克氏针内固定术,对照组予切开复位钢板内固定术。记录两组患者手术时间、术中出血量;两组患者于术前、术后、术后6周、术后3个月拍摄X线片并测量掌倾角、尺偏角及桡侧高度变化:采用视觉模拟疼痛评分(VAS)评价两组患者术后当日、术后3天、术后1周、术后6周腕关节疼痛情况;采用Gartland-Werley腕关节评分评价两组患者术后3个月、术后6个月的腕关节功能;记录两组患者术后不良反应发生情况、住院天数、治疗费用及患者满意度。采用统计学软件SPSS 22.0对统计数据进行分析。结果:两组患者基本资料比较,差异无统计学意义(P0.05)。实验组手术时间及术中出血量明显少于对照组,差异有统计学意义(P0.05);两组患者之间的术后当日、术后3天、术后1周、术后6周VAS疼痛评分比较,术后当日、术后3天、术后1周VAS疼痛评分,差异均有统计学意义(P0.05),术后6周VAS疼痛评分,差异无统计学意义(P0.05);两组患者之间的术前、术后、术后6周、术后3个月掌倾角比较,差异均无统计学意义(P0.05);两组患者之间的术前、术后桡骨高度比较,差异均无统计学意义(P0.05),术后6周、术后3个月桡骨高度比较,差异均有统计学意义(P0.05);两组患者之间的术前尺偏角比较,差异无统计学意义(P0.05),术后、术后6周、术后3个月尺偏角比较,差异均有统计学意义(P0.05);两组患者术后3个月、术后6个月复查Gartland-Werley腕关节评分评价腕关节功能,术后3个月,实验组和对照组的优良率分别为66.67%、76.67%,差异无统计学意义(P0.05),术后6个月,实验组和对照组的优良率分别为83.33%、86.67%,,差异无统计学意义(P0.05);实验组患者住院天数、治疗费用均明显低于对照组,差异有统计学意义(P0.05);实验组和对照组的不良反应发生率分别为3.33%、10.00%,差异无统计学意义(P0.05);两组患者术后3个月随访时主观满意度比较,实验组和对照组的满意率分别为93.33%、73.33%,差异无统计学意义(P0.05)。结论:两种治疗方式对于老年桡骨远端骨折均有较好的临床疗效,在恢复掌倾角、尺偏角及桡骨高度方面,手法整复结合改良克氏针内固定术低于切开复位钢板螺钉内固定术,但是后期腕关节功能恢复无差异,且前者住院天数、治疗费用均明显低于后者,前者满意度高于后者,综合考虑老年人群的特殊生理阶段,手法整复结合改良克氏针内固定术治疗桡骨远端不稳定型骨折更易被老年患者接受。
[Abstract]:Objective: to study the clinical effect of manual reduction combined with modified Kirschner needle fixation and open reduction plate screw fixation in the treatment of unstable fractures of distal radius in the elderly. To provide clinical basis for the treatment of unstable distal radius fractures in the elderly. Methods: from March 2015 to September 2016, 60 patients with distal radius fracture in Shenzhen Pingle Orthopedic and Trauma Hospital were randomly divided into experimental group and control group with 30 cases in each group. The experimental group was treated with manual reduction combined with modified Kirschner needle fixation. The control group was treated with open reduction and internal fixation with steel plate. The time of operation and blood loss during operation were recorded in both groups, and X-ray films were taken before operation, 6 weeks after operation and 3 months after operation, and the angle of palm inclination was measured. The changes of ulnar angle and radial height: visual analogue pain score (VAS) was used to evaluate the wrist joint pain on the same day, 3 days, 1 week and 6 weeks after operation, and Gartland-Werley wrist score was used to evaluate the postoperative 3 months. Wrist joint function 6 months after operation, adverse reactions, hospitalization days, treatment costs and patients' satisfaction were recorded in the two groups. The statistical data were analyzed by SPSS 22.0. Results: there was no significant difference in basic data between the two groups (P0.05). The time of operation and the amount of intraoperative bleeding in the experimental group were significantly less than those in the control group (P0.05); the VAS pain scores were compared between the two groups on the postoperative day, 3 days, 1 week, 6 weeks after operation, 3 days after operation and 6 weeks after operation. VAS pain score at 1 week after operation, the difference was statistically significant (P0.05), but there was no significant difference in VAS pain score at 6 weeks after operation (P0.05). There was no significant difference between the two groups (P0.05). There was no significant difference in the radial height between the two groups before and after operation (P0.05). The difference was statistically significant (P0.05), there was no significant difference in the preoperative ulnar deviation between the two groups (P0.05), the difference was statistically significant at 6 weeks and 3 months after operation (P0.05); 3 months after operation, there were significant differences between the two groups (P0.05). Six months after operation, Gartland-Werley wrist score was performed to evaluate wrist function. The excellent and good rates of the experimental group and the control group were 66.67 and 76.67, respectively. There was no significant difference between the two groups (P0.05), but at 6 months after operation, the excellent and good rates of the two groups were 66.67 and 76.67 respectively (P0.05). The excellent and good rates of the experimental group and the control group were 83.33 and 86.67, respectively, the difference was not statistically significant (P0.05); the days of hospitalization and the cost of treatment of the patients in the experimental group were significantly lower than those in the control group. The difference was statistically significant (P0.05); the incidence of adverse reactions in the experimental group and the control group were 3.33 and 10.00 respectively, the difference was not statistically significant (P0.05); the subjective satisfaction of the two groups was compared after 3 months follow-up. The satisfaction rates of the experimental group and the control group were 93.33 and 73.33, respectively. The difference was not statistically significant (P0.05). Conclusion: both methods have good clinical effect in the treatment of distal radius fracture in the elderly. In the recovery of palmar inclination angle, ulnar deviation angle and radius height, manual reduction combined with modified Kirschner needle internal fixation is lower than open reduction plate and screw fixation. But there was no difference in the recovery of wrist function in the later stage, and the days of hospitalization and the cost of treatment of the former were significantly lower than those of the latter, and the satisfaction of the former was higher than that of the latter. Manual reduction combined with modified Kirschner needle fixation for unstable distal radius fractures is more acceptable in elderly patients.
【学位授予单位】：广州中医药大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R687.3

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