CAJ | 학술논문

目的：比较桡骨远端骨折保守治疗与手术治疗的疗效，为临床合理诊疗提供依据。方法对2005年1月至2011年12月在我院就诊的162例桡骨远端骨折患者的临床资料进行回顾性分析。按照治疗方式分为2组：保守治疗组（保守组）95例，采用手法复位后短臂石膏夹板固定4～7周，其中男58例，女37例；年龄21～64岁，平均52．8岁；关?外骨折（A型）、部分关?内骨折（B 型）、复杂关?内骨折（C 型）分别为47、28、20例，术前掌倾角平均为－9．6°，尺倾角平均－6．3°，轴向短缩平均6．3 mm，关?面错位平均4．1 mm；均为新鲜的闭合性骨折并在骨折后8 h 内就诊。手术组67例，手术切开复位后用T 形解剖钢板螺丝钉内固定，其中男40例，女27例，年龄22～65岁，平均53．1岁；A、B、C 型骨折分别为31、22、14例，术前掌倾角平均－11．2°，尺倾角平均－7．1°，轴向短缩平均6．9 mm，关?面错位平均4．3 mm。2组治疗后随访，进行复位评分和功能评分，观察疗效。结果162例患者中，有139例患者完成了12～41个月的术后随访，平均14．5个月，其中保守组80例，手术组59例。功能评分：手术组35例优、20例良、4例中；保守组45例优、25良、8例中、2例差。优良率：手术组 A 型骨折27／29（93．10％），B 型16／17（94．12％），C 型12／13（92．31％），疗效均满意；保守组 A 型35／37（94．59％），B 型22／24（91．67％），C 型13／19（68．42％）。手术组与保守组组比较，A、B 型骨折的复位评分、功能评分差异均无统计学意义（P ＞0．05），但手术组 C 型骨折的复位评分、功能评分均显著优于保守组，差异有统计学意义（P ＜0．01）。结论对于 A、B 型骨折，采用闭合手法复位后短臂石膏夹板外固定或者手术切开复位后 T 型钢板螺丝钉内固定均可取得较好疗效，但 C 型骨折手术切开复位后内固定效果更好。目的：比較橈骨遠耑骨摺保守治療與手術治療的療效，為臨床閤理診療提供依據。方法對2005年1月至2011年12月在我院就診的162例橈骨遠耑骨摺患者的臨床資料進行迴顧性分析。按照治療方式分為2組：保守治療組（保守組）95例，採用手法複位後短臂石膏夾闆固定4～7週，其中男58例，女37例；年齡21～64歲，平均52．8歲；關?外骨摺（A型）、部分關?內骨摺（B 型）、複雜關?內骨摺（C 型）分彆為47、28、20例，術前掌傾角平均為－9．6°，呎傾角平均－6．3°，軸嚮短縮平均6．3 mm，關?麵錯位平均4．1 mm；均為新鮮的閉閤性骨摺併在骨摺後8 h 內就診。手術組67例，手術切開複位後用T 形解剖鋼闆螺絲釘內固定，其中男40例，女27例，年齡22～65歲，平均53．1歲；A、B、C 型骨摺分彆為31、22、14例，術前掌傾角平均－11．2°，呎傾角平均－7．1°，軸嚮短縮平均6．9 mm，關?麵錯位平均4．3 mm。2組治療後隨訪，進行複位評分和功能評分，觀察療效。結果162例患者中，有139例患者完成瞭12～41箇月的術後隨訪，平均14．5箇月，其中保守組80例，手術組59例。功能評分：手術組35例優、20例良、4例中；保守組45例優、25良、8例中、2例差。優良率：手術組 A 型骨摺27／29（93．10％），B 型16／17（94．12％），C 型12／13（92．31％），療效均滿意；保守組 A 型35／37（94．59％），B 型22／24（91．67％），C 型13／19（68．42％）。手術組與保守組組比較，A、B 型骨摺的複位評分、功能評分差異均無統計學意義（P ＞0．05），但手術組 C 型骨摺的複位評分、功能評分均顯著優于保守組，差異有統計學意義（P ＜0．01）。結論對于 A、B 型骨摺，採用閉閤手法複位後短臂石膏夾闆外固定或者手術切開複位後 T 型鋼闆螺絲釘內固定均可取得較好療效，但 C 型骨摺手術切開複位後內固定效果更好。
목적：비교뇨골원단골절보수치료여수술치료적료효，위림상합리진료제공의거。방법대2005년1월지2011년12월재아원취진적162례뇨골원단골절환자적림상자료진행회고성분석。안조치료방식분위2조：보수치료조（보수조）95례，채용수법복위후단비석고협판고정4～7주，기중남58례，녀37례；년령21～64세，평균52．8세；관?외골절（A형）、부분관?내골절（B 형）、복잡관?내골절（C 형）분별위47、28、20례，술전장경각평균위－9．6°，척경각평균－6．3°，축향단축평균6．3 mm，관?면착위평균4．1 mm；균위신선적폐합성골절병재골절후8 h 내취진。수술조67례，수술절개복위후용T 형해부강판라사정내고정，기중남40례，녀27례，년령22～65세，평균53．1세；A、B、C 형골절분별위31、22、14례，술전장경각평균－11．2°，척경각평균－7．1°，축향단축평균6．9 mm，관?면착위평균4．3 mm。2조치료후수방，진행복위평분화공능평분，관찰료효。결과162례환자중，유139례환자완성료12～41개월적술후수방，평균14．5개월，기중보수조80례，수술조59례。공능평분：수술조35례우、20례량、4례중；보수조45례우、25량、8례중、2례차。우량솔：수술조 A 형골절27／29（93．10％），B 형16／17（94．12％），C 형12／13（92．31％），료효균만의；보수조 A 형35／37（94．59％），B 형22／24（91．67％），C 형13／19（68．42％）。수술조여보수조조비교，A、B 형골절적복위평분、공능평분차이균무통계학의의（P ＞0．05），단수술조 C 형골절적복위평분、공능평분균현저우우보수조，차이유통계학의의（P ＜0．01）。결론대우 A、B 형골절，채용폐합수법복위후단비석고협판외고정혹자수술절개복위후 T 형강판라사정내고정균가취득교호료효，단 C 형골절수술절개복위후내고정효과경호。
Objective To compared and analyze the therapeutic effect of conservative treatment on distal radius fracture as compared with surgical treatment,so as to provide evidence for the diagnosis and treatment of distal radius fracture.Methods A retro-spective analysis was made on the clinical data of 162 patients with distal radius fracture treated in our hospital from January 2005 to De-cember 2011.In accordance with the different treatment methods,the patients were divided into 2 groups:the conservative treatment group and the surgical treatment group.The patients in the conservative treatment group consisted of 95 patients,including 58 males and 37 females,with an age range between 21 and 64,averaging 52.8 years old.There were 47 cases of extra-articular fracture (type A fracture),28 cases of partial intra-articular fracture (type B fracture)and 20 cases of complicated intra-articular fracture (type C fracture).They were fresh closed fractures and were sent to hospital within 8 hours after fracture.After manual reposition,they had plaster splint for 4 to 7 weeks.The surgical treatment group contained 40 male and 27 female patients,with an age range between 22 and 65,averaging 53.1 years old.The control group included 31 type A fractures,22 type B fractures and 14 type C fractures.T-form steel plates were used for fixation of fractures after surgical reposition.Medical follow-ups were performed 12 to 41 months after surgery (averaging 14.5 months),and therapeutic effects were observed by using reposition scores and function test scores.Results Of the <br> 162 patients,139 patients fulfilled the 12 to 41-month (averaging 14.5 months)medical follow-ups,including 80 cases in the conser-vative treatment group and 59 cases in the surgery group.With regard to function test scores,35 cases were of excellent rate,20 cases were of good rate and 4 cases were of moderate rate for the surgical treatment group.As for the conservative treatment group,45 cases were of excellent rate,25 cases were of good rate,8 cases were of moderate rate and 2 cases were of poor rate.Excellent rates for type A,B and C fractures accounted for 89.47% (17 /19),94.12% (16 /17)and 92.31% (12 /13)respectively,all with satisfactory therapeutic results.As for conservative treatment group,excellent rates for type A,B and C fractures accounted for 94.59% (35 /37), 91.67% (22 /24)and 68.42% (13 /19)respectively.There was no statistical significance in the reposition scores of type A and B fractures and function test scores,when comparisons were made between the surgical and conservative treatment groups(P >0.05). However,the reposition scores of type C fracture and function test scores for the surgical treatment group were obviously superior to those of the conservative treatment group,with statistical significance (P <0.01).Conclusion As for type A and B fractures,manual reposition plus external splint fixation and surgical reposition plus internal fixation could all achieve relatively good therapeutic results, whereas surgical reposition plus internal fixation for type C fracture could achieve better results.