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中华临床医师杂志(电子版) ›› 2022, Vol. 16 ›› Issue (06) : 487 -492. doi: 10.3877/cma.j.issn.1674-0785.2022.06.005

所属专题: 骨科学

临床研究

老年桡骨远端关节内骨折保守与掌侧锁定钢板手术治疗的疗效比较
吕鹏飞1, 裴征1, 张清华1, 刘家帮1,()   
  1. 1. 100144 北京大学首钢医院骨科
  • 收稿日期:2021-10-27 出版日期:2022-06-15
  • 通信作者: 刘家帮

Comparison of conservative treatment and volar locking plate surgery in treating intra-articular distal radius fractures in elderly patients

Pengfei Lv1, Zheng Pei1, Qinghua Zhang1, Jiabang Liu1,()   

  1. 1. Department of Orthopedics, Peking University Shougang Hospital, Beijing 100144, China
  • Received:2021-10-27 Published:2022-06-15
  • Corresponding author: Jiabang Liu
引用本文:

吕鹏飞, 裴征, 张清华, 刘家帮. 老年桡骨远端关节内骨折保守与掌侧锁定钢板手术治疗的疗效比较[J/OL]. 中华临床医师杂志(电子版), 2022, 16(06): 487-492.

Pengfei Lv, Zheng Pei, Qinghua Zhang, Jiabang Liu. Comparison of conservative treatment and volar locking plate surgery in treating intra-articular distal radius fractures in elderly patients[J/OL]. Chinese Journal of Clinicians(Electronic Edition), 2022, 16(06): 487-492.

目的

比较保守与掌侧锁定钢板手术治疗老年桡骨远端关节内骨折的关节活动度及功能评分。

方法

回顾性研究2017年1月至2019年12月期间于北京大学首钢医院骨科进行治疗的桡骨远端关节内骨折患者,共75例。其中33例患者采用手法复位及石膏外固定治疗,42例患者采用掌侧锁定钢板手术治疗,根据2组患者治疗后12个月的腕关节活动度及上肢功能损伤(DASH)评分评价其疗效。

结果

保守组患者关节活动度:背伸(60.7±7.2)°;掌屈(53.6±10.5)°;旋前(83.9±8.9)°;旋后(83.8±7.7)°;桡偏(23.2±8.1)°;尺偏(36.2±7.8)°;DASH评分(11.1±9.4)分。手术组患者关节活动度:背伸(58.2±9.4)°;掌屈(50.1±10.0)°;旋前(83.1±8.8)°;旋后(83.9±8.4)°;桡偏(22.8±7.0)°;尺偏(37.5±7.4)°;DASH评分(9.8±10.8)分,2组间比较差异无统计学意义(P>0.05)。

结论

保守和掌侧锁定钢板均为治疗老年桡骨远端关节内骨折的有效治疗手段,二者间无明显治疗差异,临床治疗中应根据患者具体情况,选择合适的治疗方式。

Objective

To compare the range of motion and functional scores of distal radius intraarticular fractures in elderly patients after conservative and volar locking plate surgery.

Methods

A total of 75 patients with intra-articular fractures of the distal radius treated at Peking University Shougang Hospital from January 2017 to December 2019 were retrospectively studied. Among them, 33 patients were treated by manual reduction and plaster external fixation, and 42 patients were treated by volar locking plate surgery. The efficacy of the two groups was evaluated by wrist motion and Disabilities of the Arm, Shoulder and Hand (DASH) score at 12 months after treatment.

Results

The parameters of range of motion in the conservative group were the following: dorsiflexion, (60.7±7.2)°; palmar flexion, (53.6±10.5)°; pronation, (83.9±8.9)°; supination, (83.8±7.7)°; radial deviation, (23.2±8.1)°; ulnar deviation, (36.2±7.8)°; DASH score, 11.1±9.4; the corresponding parameters in the operation group were (58.2±9.4)°, (50.1±10.0)°, (83.1±8.8)°, (83.9±8.4)°, (22.8±7.0)°, (37.5±7.4)°, and (9.8±10.8). There was no significant difference in these parameters between the two groups (P>0.05).

Conclusion

Both conservative treatment and volar locking plate surgery are effective in the treatment of intra-articular fractures of the distal radius in the elderly. There is no significant difference between the two. The appropriate treatment should be selected according to the specific conditions of patients.

表1 2组患者的一般资料比较
表2 2组患者腕关节功能比较(
xˉ
±s
图1 典型病例1,女性,66岁,桡骨远端关节内骨折,行手法复位及石膏外固定治疗。图a、b为治疗前腕关节正侧位X线;图c、d为治疗后腕关节正侧位X线;图e、f为治疗后12个月腕关节正侧位X线
图2 典型病例2,女性,69岁,桡骨远端关节内骨折,行切开复位内固定手术治疗。图a、b为治疗前腕关节正侧位X线;图c、d为治疗后腕关节正侧位X线;图e、f为治疗后12个月腕关节正侧位X线
1
姜保国, 张殿英, 付中国, 等. 桡骨远端骨折的治疗建议 [J]. 中华创伤骨科杂志, 2010, 12(11):1053-1056.
2
Levin LS, Rozell JC, Pulos N. Distal radius fractures in the elderly [J]. J Am Acad Orthop Surg, 2017, 25(3): 179-187.
3
Chung KC, Shauver MJ, Birkmeyer JD. Trends in the United States in the treatment of distal radial fractures in the elderly [J]. J Bone Joint Surg Am, 2009, 91(8): 1868-1873.
4
李庭, 米萌, 刘洪波, 等. 加速康复外科理念下桡骨远端骨折规范化无痛闭合整复与石膏固定方案优化的专家共识 [J]. 中华骨与关节外科杂志, 2020, 13(3): 177-182.
5
陈振兵, 洪光祥, 王发斌. 上肢功能评定表 [J]. 中国修复重建外科杂志, 2004, 18(6): 520-521.
6
Macintyre NJ, Dewan N. Epidemiology of distal radius fractures and factors predicting risk and prognosis [J]. J Hand Ther, 2016, 29(2): 136-145.
7
Mauck BM, Swigler CW. Evidence-based review of distal radius fractures [J]. Orthop Clin North Am, 2018, 49(2): 211-222.
8
Ochen Y, Peek J, van der Velde D, et al. Operative vs nonoperative treatment of distal radius fractures in adults: a systematic review and meta-analysis [J]. JAMA Netw Open, 2020, 3(4): e203497.
9
Bruyere A, Vernet P, Botero SS, et al. Conservative treatment of distal fractures after the age of 65: a review of literature [J]. Eur J Orthop Surg Traumatol, 2018, 28(8): 1469-1475.
10
Schneppendahl J, Windolf J, Kaufmann RA. Distal radius fractures: current concepts [J]. J Hand Surg Am, 2012, 37(8): 1718-1725.
11
Liporace FA, Adams MR, Capo JT, et al. Distal radius fractures [J]. J Orthop Trauma, 2009, 23(10): 739-748.
12
Grewal R, Macdermid JC. The risk of adverse outcomes in extra-articular distal radius fractures is increased with malalignment in patients of all ages but mitigated in older patients [J]. J Hand Surg Am, 2007, 32(7): 962-970.
13
Dayican A, Unal V S, Ozkurt B, et al. Conservative treatment in intra-articular fractures of the distal radius: a study on the functional and anatomic outcome in elderly patients [J]. Yonsei Med J, 2003, 44(5): 836-840.
14
Young BT, Rayan GM. Outcome following nonoperative treatment of displaced distal radius fractures in low-demand patients older than 60 years [J]. J Hand Surg Am, 2000, 25(1): 19-28.
15
Chung KC, Shauver MJ, Yin H. The relationship between ASSH membership and the treatment of distal radius fracture in the United States medicare population [J]. J Hand Surg Am, 2011, 36(8): 1288-1293.
16
贡小英, 荣国威, 安贵生, 等. 桡骨远端不稳定骨折掌侧或背侧内固定的选择 [J]. 中华外科杂志, 2003, 41(6): 436-440.
17
Miller JE, Naram A, Qin B, et al. Distal radius fractures in the elderly: use of the volar bearing plate [J]. Ann Plast Surg, 2019, 82(1): 34-38.
18
Figl M, Weninger P, Jurkowitsch J, et al. Unstable distal radius fractures in the elderly patient--volar fixed-angle plate osteosynthesis prevents secondary loss of reduction [J]. J Trauma, 2010, 68(4): 992-998.
19
Dijkstra PU, Groothoff JW, Ten DH, et al. Incidence of complex regional pain syndrome type I after fractures of the distal radius [J]. Eur J Pain, 2003, 7(5): 457-462.
20
Field J, Protheroe DL, Atkins RM. Algodystrophy after Colles fractures is associated with secondary tightness of casts [J]. J Bone Joint Surg Br, 1994, 76(6): 901-905.
21
Mathews AL, Chung KC. Management of complications of distal radius fractures [J]. Hand Clin, 2015, 31(2): 205-215.
22
Lee DS, Weikert DR. Complications of distal radius fixation [J]. Orthop Clin North Am, 2016, 47(2): 415-424.
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