特制牵引夹板与石膏固定治疗移位型桡骨远端骨折随机对照研究

doi:10.13418/j.issn.1001-165x.2023.4.19

中国临床解剖学杂志 ›› 2023, Vol. 41 ›› Issue (4): 481-486.doi: 10.13418/j.issn.1001-165x.2023.4.19

特制牵引夹板与石膏固定治疗移位型桡骨远端骨折随机对照研究

李鑫¹，殷渠东¹*，韦旭明^1,2，杨澔侠³，陆尧¹，刘军¹，芮永军¹

1.苏州大学附属无锡市第九人民医院骨科，江苏无锡 214062； 2.无锡市新吴区新瑞医院骨科，江苏无锡 214060；
3.苏州大学附属无锡市第九人民医院骨伤科，江苏无锡 214062

收稿日期:2023-06-27 出版日期:2023-07-25 发布日期:2023-08-02
通讯作者: 殷渠东，博士，主任医师，E-mail： yinqudong@sina.com
作者简介:李鑫（1984-），男，安徽安庆人，住院医师，研究方向：创伤骨科，E-mail：wxsyqd@163.com
基金资助:
无锡市中管局课题（ZYKJ202010, ZYKJ202008）；无锡市“太湖人才计划”顶尖医学团队课题（WXTMETTHP-07）

A randomized controlled study of special traction splint vs cast immobilization in the treatment of displaced distal radius fractures

Li Xin¹, Yin Qudong¹*, Wei Xuming ^{1, 2}, Yang Haoxia³, Lu Yao¹, Liu Jun¹, Rui Yongjun¹

1. Department of Orthopaedics, Wuxi No.9 People’s Hospital Affiliated to Suzhou University, Wuxi 214062, China; 2. Department of Orthopedics, Wuxi Xinwu District Xinrui Hospital, Wuxi 214060, China; 3. Orthopedics and Traumatology, Wuxi No.9 People’s Hospital Affiliated to Suzhou University, Wuxi 214062, China

Received:2023-06-27 Online:2023-07-25 Published:2023-08-02

摘要/Abstract

摘要： 目的探讨特制牵引夹板与石膏固定治疗移位型桡骨远端骨折的效果，阐明本牵引夹板治疗原理。方法将符合纳入标准、保守治疗70例移位型桡骨远端骨折随机分为实验组（牵引夹板固定，35例）和对照组（石膏固定，35例）。两组患者年龄、性别、骨折类型、固定时机和疼痛视觉模拟评分（VAS）等无统计学差异（P>0.05）。比较两组骨折愈合相关指标。结果实验组再移位、不可接受移位和手术率少于对照组，差异有统计学意义（P<0.05），两组骨折愈合和外固定时间无统计学差异（P>0.05）。所有患者随访10~18个月，平均12.2个月，末次随访，实验组桡骨高度和尺偏角优于对照组，差异有统计学意义（P<0.05），而掌倾角、尺桡侧倾范围、腕屈伸范围、旋转范围、手握力、VAS、自行评估量表评分（patient-rated wrist evaluation，PRWE）和腕关节功能（Gartland-Werley）优良率比较，无统计学差异（P>0.05）。结论牵引夹板较石膏固定能更好维持桡骨远端骨折位置和桡骨高度，减少再移位和手术率。

关键词: 桡骨远端骨折； , , 夹板； , , 石膏； , , 牵引夹板； , , 纵向牵引

Abstract: Objective To investigate the effect of special traction splint vs plaster immobolization in the treatment of distal radius fractures and clarify the mechanism of traction splint. Methods Total of 70 patients with displaced distal radius fractures treated conservatively were randomly divided into an experimental group ( traction splint immobolization, 35 cases) and a control group (plaster immobolization , 35 cases). There was no significant difference in age, gender, fracture type and fixation timing, and visual analog scale (VAS) for pain between the two groups (P>0.05). The fracture healing and fixation time, re-displacement, unacceptable displacement, operation rate, radius height, radial inclination angle, palmar inclination, range of motion (ROM) of radial-ulnar inclination，flection- extension and rotation, VAS for pain, hand grip strength, patient-rated wrist evaluation (PRWE) and wrist functional recovery (Gartland- Werley’s method) were compared between the two groups. Results The re-displacement, unacceptable displacement and operation rate of the experimental group were less than those of the control group, and the differences were statistically significant (P<0.05). There was no significant difference in fracture healing time and fixation time between the two groups (P>0.05). All the patients were followed-up for 10 to 18 months, with an average follow-up of 12.2 months. At the last follow-up, the radius height and radius inclination angle of the experimental group were better than those of the control group, and the differences were statistically significant (P<0.05). However, there was no significant difference in the palmar inclination, ROMs of radius-ulnar inclination, flection-extension and rotation, VAS, hand grip strength, patient-rated wrist evaluation (PRWE), and excellent to good rate of wrist function between the two groups (P>0.05). Conclusions Comparing with plaster, traction splint immobolization can better maintain the position of distal radius fracture and the height of radius, reduce the re-displacement and operation rate, and the overall effect is better.

Key words: Distal radius fracture; , , Splint; , , Plaster; , , Traction splint; , , Longitudinal traction

中图分类号:

R683.41

李鑫, 殷渠东, 韦旭明, 杨澔侠, 陆尧, 刘军, 芮永军. 特制牵引夹板与石膏固定治疗移位型桡骨远端骨折随机对照研究[J]. 中国临床解剖学杂志, 2023, 41(4): 481-486.

Li Xin, Yin Qudong, Wei Xuming, Yang Haoxia, Lu Yao, Liu Jun, Rui Yongjun . A randomized controlled study of special traction splint vs cast immobilization in the treatment of displaced distal radius fractures[J]. Chinese Journal of Clinical Anatomy, 2023, 41(4): 481-486.

参考文献 21

[1]	丁玲, 唐文, 高慧秋, 等. 两类桡骨远端die-punch骨折的影像学比较[J]. 中国临床解剖学杂志, 2020, 38(1): 83-87. DOI: 10.13418/j.issn.1001-165x.2020.01.017.
[2]	赵景新, 马雅昌, 朱雅文, 等. 3D打印用于青少年Salter-HarrisⅡ型桡骨远端骨折辅助治疗的临床效果分析[J]. 中国临床解剖学杂志, 2018, 36(3): 346-348, 351. DOI: 10.13418/j.issn.1001-165x.2018.03.023.
[3]	欧梁, 卢敏, 张永辉, 等. 手法复位小夹板固定治疗老年桡骨远端骨折临床疗效Meta分析[J]. 中国中西医结合杂志, 2019, 39(1): 57-62. DOI: 10.7661/j.cjim.20171001.316.
[4]	蔡效信. 手术与非手术治疗桡骨远端骨折对患者腕关节功能恢复的影响[J]. 湖南中医药大学学报, 2016, 36(9): 72-74. DOI: 10.3969/j.issn.1674-070X.2016.09.019.
[5]	李绍良, 高志强, 鲁谊, 等. 保守治疗60岁以上桡骨远端骨折的可行性研究[J]. 中华创伤骨科杂志, 2012, 14(9): 763-766. DOI: 10.3760/cma.j.issn.1671-7600.2012.09.007.
[6]	Arora R, Lutz M, Deml C, et al. A prospective randomized trial comparing nonoperative treatment with volar locking plate fixation for displaced and unstable distal radial fractures in patients sixty-five years of age and older[J]. J Bone Joint Surg Am, 2011, 93(23): 2146-2153. DOI: 10.2106/JBJS.J.01597.
[7]	Hassellund S, Zolic-Karlsson Z, Williksen JH, et al. Surgical treatment is not cost-effective compared to nonoperative treatment for displaced distal radius fractures in patients 65 years and over[J]. Bone Jt Open, 2021, 2(12): 1027-1034. DOI: 10.1302/2633-1462.212.BJO-2021-0108.R1.
[8]	Hassellund SS, Williksen JH, Laane MM, et al. Cast immobilization is non-inferior to volar locking plates in relation to QuickDASH after one year in patients aged 65 years and older: a randomized controlled trial of displaced distal radius fractures[J]. Bone Joint J, 2021, 103-B(2): 247-255. DOI: 10.1302/0301-620X.103B2.BJJ-2020-0192.R2.
[9]	史秀罡, 郑春伟, 陆羽羽. 石氏伤科小夹板外固定加平衡牵引防治桡骨远端骨折短缩移位临床研究[J]. 河南中医, 2020, 40(10): 1573-1576. DOI: 10.16367/j.issn.1003-5028.2020.10.0399.
[10]	王海洲, 冯恩辉, 陈平. 手法整复小夹板外固定配合悬吊牵引治疗桡骨远端骨折临床研究[J]. 新中医, 2015, 47(1): 116-118. DOI: 10.13457/j.cnki.jncm.2015.01.056.
[11]	冯恩辉, 魏力, 王海洲, 等. 持续牵引器预防干骺端粉碎桡骨远端骨折复位丢失临床研究[J]. 新中医, 2016, 48(10): 112-114. DOI: 10.13457/j.cnki.jncm.2016.10.047.
[12]	杨玉元, 杨静, 张宏刚, 等. 自制偏心牵引带在桡骨远端骨折中的临床应用[J]. 中国骨伤, 2013, 26(8): 693-695. DOI: 10.3969/j.issn.1003-0034.2013.08.018.
[13]	唐珍岁. 手法整复小夹板外固定配合悬吊牵引治疗桡骨远端骨折的临床观察[J]. 中医临床研究, 2013, 5(3): 101-102. DOI: 10.3969/j.issn.1674-7860.2013.03.062.
[14]	颜威, 孔博, 蒋涛, 等. 桡骨远端骨折新型夹板的临床验证及改良设计[J]. 中国组织工程研究, 2018, 22(27): 4294-4299. DOI: 10.3969/j.issn.2095-4344.0342.
[15]	米萌, 李庭, 高志强. 桡骨远端骨折的规范化无痛闭合整复与石膏固定[J]. 骨科临床与研究杂志, 2019, 4(2): 123-128. DOI: 10.19548/j.2096-269x.2019.02.015.
[16]	Selles CA, Mulders MAM, Winkelhagen J, et al. Volar plate fixation versus cast immobilization in acceptably reduced intra-articular distal radial fractures: a randomized controlled trial[J]. J Bone Joint Surg Am, 2021, 103(21): 1963-1969. DOI: 10.2106/JBJS.20.01344.
[17]	Gartland JJ Jr, Werley CW. Evaluation of healed Colles' fractures[J]. J Bone Joint Surg Am, 1951, 33A(4): 895-907. PMID: 14880544.
[18]	肖鸿鹄, 李庭, 米萌, 等. 加速康复外科在创伤骨科无痛闭合整复桡骨远端骨折的前瞻性队列研究[J]. 中华创伤骨科杂志, 2019, 21(11): 945-951. DOI: 10.3760/cma.j.issn.1671-7600.2019.11.004.
[19]	Zhang P, Jia B, Chen XK, et al. Effects of surgical and nonoperative treatment on wrist function of patients with distal radius fracture[J]. Chin J Traumatol, 2018,21(1):30-33. DOI: 10.1016/j.cjtee. 2017. 11. 004.
[20]	郑上团, 吴斗, 郝海虎, 等. 桡骨远端骨折的治疗进展[J]. 中华骨科杂志,2016, 36(5): 314-320. DOI: 10.3760/cma.j.issn.0253-2352. 2016. 05. 009.
[21]	王簕, 杨云峰, James F Kellam. 老年人桡骨远端骨折手术治疗与非手术治疗的比较[J]. 中华创伤骨科杂志, 2011, 13(6): 579-588. DOI: 10.3760/cma.j.issn.1671-7600.2011.06.019.

特制牵引夹板与石膏固定治疗移位型桡骨远端骨折随机对照研究

A randomized controlled study of special traction splint vs cast immobilization in the treatment of displaced distal radius fractures

PDF (PC)

可视化

摘要/Abstract

引用本文

使用本文

参考文献 21

相关文章 15

Metrics

本文评价

推荐阅读 0

[1]	江剑宏, 段仁鹏, 李晓锋. 国人胆道三维重建解剖变异应用研究[J]. 中国临床解剖学杂志, 2024, 42(1): 1-4.
[2]	郭红志, 王瑜, 张加琪, 梁海彬, 马梓玮, 冯伟, 吴忧, 司子燚. 血管铸型结合CT三维模型评估先兆子痫胎盘血管结构[J]. 中国临床解剖学杂志, 2024, 42(1): 5-10.
[3]	李佳伟, 张静, 李灿然, 兰文杰, 籍庆余, 郭志勇, 张云凤, 刘启, 陈清威, 李筱贺. 蒙古族人群股骨近端解剖参数X线测量[J]. 中国临床解剖学杂志, 2024, 42(1): 11-16.
[4]	李琨, 张燕, 郭冉, 郝咪咪, 吴轩宇, 徐艺芳, 王超群, 马文童, 张灵淇, 杨宏宇, 李志军, 张少杰, 王星. 儿童及青少年枕颈角与后枕颈角数字化测量及其临床意义[J]. 中国临床解剖学杂志, 2024, 42(1): 17-20.
[5]	李文, 杨思艺, 黄蕾, 卿霁雯, 蒋松涛, 张磊. 基于MRI探讨Lisfranc韧带的形态学特点及临床意义[J]. 中国临床解剖学杂志, 2024, 42(1): 21-25.
[6]	李凡凡, 徐阳, 王晓旭. 紫草素调节Nrf2/HO-1信号通路对实验性大鼠肉芽肿性小叶性乳腺炎的治疗作用研究[J]. 中国临床解剖学杂志, 2024, 42(1): 26-32.
[7]	王兴航, 丁佳媛, 李放, 包翠芬, 阎丽菁. 人参皂苷Rg1通过抑制NLRP3炎症小体途径减轻氧糖剥夺/复供后小胶质细胞炎症反应[J]. 中国临床解剖学杂志, 2024, 42(1): 33-41.
[8]	程莹莹, 武建军, 蔡海燕, 焦旭文, 马江波, 丁银秀. 体外炎性诱导星形胶质细胞激活及功能分析[J]. 中国临床解剖学杂志, 2024, 42(1): 42-46.
[9]	祁志, 杨力, 贾秋叶, 陈浩伦, 段兆达, 吴春云. 依达拉奉经MAPKs通路对脂多糖激活的小胶质细胞Sirt3表达调控[J]. 中国临床解剖学杂志, 2024, 42(1): 47-53.
[10]	张晶晶, 王洪新. 黄芩苷通过PDGF/P38 MAPK信号通路对肺动脉高压大鼠的保护作用[J]. 中国临床解剖学杂志, 2024, 42(1): 54-58.
[11]	乐钦, 陈荣丽, 熊婧熙, 王婷怡, 蔡志恒, 易秋实, 曾心怡. 白芨多糖对大鼠跨区皮瓣choke区的影响[J]. 中国临床解剖学杂志, 2024, 42(1): 59-64.
[12]	李笑予, 张磊, 付磊, 李东波, 汪国友. 三步接骨法治疗Sanders Ⅱ型跟骨骨折的有限元研究[J]. 中国临床解剖学杂志, 2024, 42(1): 65-70.
[13]	吴研飞, 马剑雄, 卢斌, 王颖, 柏豪豪, 靳洪震, 马信龙. CT后处理技术重建CT值与终板抗压强度的相关性研究[J]. 中国临床解剖学杂志, 2024, 42(1): 71-76.
[14]	庄万强, 唐毅, 骆勇刚, 张辉. 关节镜联合胫骨高位截骨术对髌骨位置及髌股关节功能影响的早中期回顾性研究[J]. 中国临床解剖学杂志, 2024, 42(1): 77-82.
[15]	罗鹰, 窦伟誉, 吴小杭, 陈璟昆, 彭昌贵, 潘剑英 . 微创海马钢板内固定治疗跟骨骨折并发症的影响因素[J]. 中国临床解剖学杂志, 2024, 42(1): 83-88.