CAJ | 학술논문

目的：探讨桡骨远端骨折夹板外固定治疗腕关节功能恢复的影响因素，为提高临床疗效提供依据。方法150例桡骨远端骨折的患者，行手法复位夹板外固定后，随访9～12个月，首先进行单因素分析，采用χ2检验对年龄、性别、掌倾角背伸是否＜10°、尺倾角是否＞15°、短缩畸形是否＞5 mm、骨折类型、有无骨质疏松、是否为严重粉碎性骨折、是否肿胀、固定后1周内是否复查、有无进行功能锻炼共11个因素与桡骨远端骨折夹板外固定治疗腕关节功能恢复相关关系进行单因素分析，逐一剔除无统计学意义的变量。在单因素分析的基础上，采用多因素 Logistic 回归分析影响桡骨远端骨折夹板外固定治疗腕关节功能恢复的因素。结果Gartland 及 Werley 腕关节评分89例患者评定为优，32例患者评定为良，21例患者评定为可，8例患者评定为差，优良率80．67％。年龄＞60岁组与年龄≤60岁组优良率分别为75．73％、91．49％；56例男患者与94例女患者优良率分别为71．42％、86．17％；短缩畸形＞5 mm 组与≤5 mm 组优良率分别为46．81％、96．11％；CooneyⅠ、Ⅱ组（关节外骨折组）与 CooneyⅢ、Ⅳ（关节外骨折组）优良率分别为96．26％、41．86％；骨质疏松组和无骨质疏松组优良率分别为78．72％、83．93％；粉碎性骨折组与非粉碎性骨折组优良率分别为25．00％、93．44％；1周内复查组和1周无复查组优良率分别为98．31％、12．90％，以上差异均有统计学意义。结论骨折类型、严重粉碎、复查3个因素是影响桡骨远端骨折夹板外固定治疗腕关节功能恢复的主要因素。桡骨远端骨折夹板外固定治疗腕关节功能恢复除了与骨折本身的特点和受伤的程度有关外，人为可控因素应受到重视，门诊一定要向患者交代病情及相关注意事项，尤其是第一周的来院复查显得尤为重要。目的：探討橈骨遠耑骨摺夾闆外固定治療腕關節功能恢複的影響因素，為提高臨床療效提供依據。方法150例橈骨遠耑骨摺的患者，行手法複位夾闆外固定後，隨訪9～12箇月，首先進行單因素分析，採用χ2檢驗對年齡、性彆、掌傾角揹伸是否＜10°、呎傾角是否＞15°、短縮畸形是否＞5 mm、骨摺類型、有無骨質疏鬆、是否為嚴重粉碎性骨摺、是否腫脹、固定後1週內是否複查、有無進行功能鍛煉共11箇因素與橈骨遠耑骨摺夾闆外固定治療腕關節功能恢複相關關繫進行單因素分析，逐一剔除無統計學意義的變量。在單因素分析的基礎上，採用多因素 Logistic 迴歸分析影響橈骨遠耑骨摺夾闆外固定治療腕關節功能恢複的因素。結果Gartland 及 Werley 腕關節評分89例患者評定為優，32例患者評定為良，21例患者評定為可，8例患者評定為差，優良率80．67％。年齡＞60歲組與年齡≤60歲組優良率分彆為75．73％、91．49％；56例男患者與94例女患者優良率分彆為71．42％、86．17％；短縮畸形＞5 mm 組與≤5 mm 組優良率分彆為46．81％、96．11％；CooneyⅠ、Ⅱ組（關節外骨摺組）與 CooneyⅢ、Ⅳ（關節外骨摺組）優良率分彆為96．26％、41．86％；骨質疏鬆組和無骨質疏鬆組優良率分彆為78．72％、83．93％；粉碎性骨摺組與非粉碎性骨摺組優良率分彆為25．00％、93．44％；1週內複查組和1週無複查組優良率分彆為98．31％、12．90％，以上差異均有統計學意義。結論骨摺類型、嚴重粉碎、複查3箇因素是影響橈骨遠耑骨摺夾闆外固定治療腕關節功能恢複的主要因素。橈骨遠耑骨摺夾闆外固定治療腕關節功能恢複除瞭與骨摺本身的特點和受傷的程度有關外，人為可控因素應受到重視，門診一定要嚮患者交代病情及相關註意事項，尤其是第一週的來院複查顯得尤為重要。
목적：탐토뇨골원단골절협판외고정치료완관절공능회복적영향인소，위제고림상료효제공의거。방법150례뇨골원단골절적환자，행수법복위협판외고정후，수방9～12개월，수선진행단인소분석，채용χ2검험대년령、성별、장경각배신시부＜10°、척경각시부＞15°、단축기형시부＞5 mm、골절류형、유무골질소송、시부위엄중분쇄성골절、시부종창、고정후1주내시부복사、유무진행공능단련공11개인소여뇨골원단골절협판외고정치료완관절공능회복상관관계진행단인소분석，축일척제무통계학의의적변량。재단인소분석적기출상，채용다인소 Logistic 회귀분석영향뇨골원단골절협판외고정치료완관절공능회복적인소。결과Gartland 급 Werley 완관절평분89례환자평정위우，32례환자평정위량，21례환자평정위가，8례환자평정위차，우량솔80．67％。년령＞60세조여년령≤60세조우량솔분별위75．73％、91．49％；56례남환자여94례녀환자우량솔분별위71．42％、86．17％；단축기형＞5 mm 조여≤5 mm 조우량솔분별위46．81％、96．11％；CooneyⅠ、Ⅱ조（관절외골절조）여 CooneyⅢ、Ⅳ（관절외골절조）우량솔분별위96．26％、41．86％；골질소송조화무골질소송조우량솔분별위78．72％、83．93％；분쇄성골절조여비분쇄성골절조우량솔분별위25．00％、93．44％；1주내복사조화1주무복사조우량솔분별위98．31％、12．90％，이상차이균유통계학의의。결론골절류형、엄중분쇄、복사3개인소시영향뇨골원단골절협판외고정치료완관절공능회복적주요인소。뇨골원단골절협판외고정치료완관절공능회복제료여골절본신적특점화수상적정도유관외，인위가공인소응수도중시，문진일정요향환자교대병정급상관주의사항，우기시제일주적래원복사현득우위중요。
Objective To investigate influence factors of wrist joint function recovery in splint external fixation of distal radius fractures and provide references for improving the clinical curative effect. Methods One hundred and fifty cases of distal radius fractures treated by splint external fixation from August 2012 to August 2013 in our department were analyzed retrospectively.All patients were followed up for 9 to 12 months.Univariate analysis was performed byχ2 based on age,gender,palm tilt,ulnar inclina-tion,shortening deformation,fracture type,osteoporosis,severe comminuted fracture,swelling,review,func-tional exercise and so on.Multivariate logistic regression analysis was also applied for further analysis of influence factors.Results One hundred and fifty cases of distal radius fractures were followed up for 9 to 12 months,with an average of 11 months.Gartland and Werley Score showed excellent in 89 cases,good in 32 cases,fair in 21 cases,and poor in 8 cases.The over-all excellent and good rate was 80.67%.Among of them,the excellent and good rates were 75.73% in patients over 60 years and 91.49% in patients less than or equal to 60 years;71.42% in 56 male cases and 86.17% in 94 female cases;96.11% in patients with deformation less than 5 mm and 46.81% in patients with deformation greater than 5 mm;96.26% in CooneyⅠandⅡgroup and 41.86% in Cooney Ⅲ and Ⅳ group;78.72% in non-osteoporosis group and 83.93% in osteoporosis group;25.00% in non-comminuted fracture group and 93.44% in comminuted fractures group;98.31% in review group(within a week)and 12.90% in control group(over a week),re-spectively.The above differences were all significant between groups(P <0.05).Conclusion Fracture type,severe comminuted fracture,and review are the main factors related to wrist joint function recovery in splint external fixation of distal radius fractures.Beside the fracture characteristic of and injury extent,arti-ficial controllable factors should be taken seriously in wrist joint function recovery.Condition and related matters needing attention should be informed to outpatients,especially the review in the first week.