老年患者简单桡骨远端骨折手术治疗和保守治疗疗效对比分析

摘要

目的 比较老年患者(≥60岁)简单(AO 分型的A2、A3、B1型)的桡骨远端骨折手术治疗和保守治疗的疗效.方法 回顾性分析2005年12月-2008年10月就诊于北京大学第三医院的年龄≥60岁的简单的桡骨远端骨折患者的临床资料.64例患者按照治疗方式分为2组:保守治疗组40例,其中男2例,女38例,平均年龄67.1岁,短臂石膏夹板固定4～7周.骨折的AO分型为:A2型30例、A3型8例、B1型2例.40例患者均在骨折后10 h内就诊,全部为新鲜的闭合性骨折.手术组24例,其中男5例,女19例,平均年龄67.6岁.骨折的AO 分型为:A2型15例、A3型7例、B1型2例.16例患者行掌侧切开复位内固定术、8例患者行外固定支架固定.2组患者均行掌倾角和尺偏角的测量,并进行Cooney评分和DASH评分比较.结果 保守治疗组患者38例得到随访,平均随访时间28.4个月;手术组患者23例得到随访,平均随访时间29.9个月.手术组全部患者得到解剖复位,而保守治疗组患者10例畸形愈合.手术组患者平均尺偏角为23.8°,平均掌倾角为11.6°;保守治疗组平均尺偏角为19.4°,平均掌倾角为7.9°.Cooney评分手术组13例为优、9例为良、1例为中,手术组患者均对疗效满意;保守组患者14例为优、14为良、8例为中、2例为差.DASH评分手术组5.8分,保守组13.0分.2组Cooney评分间差异无统计学意义 (P=0.062),而DASH 评分间差异有统计学意义(P=0.006).结论 对于老年患者简单的桡骨远端骨折,手术治疗的疗效优于短臂石膏夹板治疗的疗效.%Objective To compare the effect of surgical treatment and conservative methods for the aged ( ＞59yrs ) people who suffered the simple displaced distal radius fracture ( AO classification A2, A3 or B1 ) . Methods Retrospectively analyse 2 cohorts 64 patients who were treated by surgery or splint in PUTH traumatic center from Dec. 2005 to Oct. 2008. In conservative treatment group , there were 40 patients , average age was 67. 1 , 2 male and 38 female , the classification : A2 30, A3 8 , B1 2. All the patients in this group were treated in 3 days after injury and were fixed by splint 4 - 7 weeks. In surgical group ,there were 24 patient, average age was 67. 6, 5 male and 19 female. The classification : A2 15 , A3 7 , B1 2. 16 patients were operated by using palmar internal fixation. And the others were fixed by external fixation. For this 2 groups, measure the ulnar tilts and palmar tilts; record the Cooney score and DASH score. And we used SPSS 17. 0 for the statistical calculation. Results 38 patients were followed up 28. 4 ( 24 - 34 ) months in splint group, while 23 patients were followed - up 29. 9 ( 25 ～44 ) months in surgical group. All the fractures were healed. There were 10 malunion in non - operation group , but none in surgical group. In surgical group, average ulnar tilts were 23. 8° ( 18°- 25° ); average palmar tilts were 11. 6° ( 7° - 15° ) . But in the conservative group, average ulnar tilts were 19. 4° ( 11° -26° ); average palmar tilts were 7. 9° ( - 15° - 35° ) . According to Cooney score , in non - operation group there were 14 excellent, 14 good, 8 fair, 2 poor, 15. 8％ patients wanted to change their treatment; in surgical group, there were 13 excellent, 9 good, and 1 fair. And the average DASH score in conservative group were 13. 0 ; in operational group were 5. 8. There was no statistical significance in Cooney score between 2 groups, but did in DASH score. Conclusion For aged people, the results of short time follow - up demonstrated the surgical treatment is better than the non - operation ways.