本文選題：橈骨遠端骨折 + 不穩(wěn)定骨折　； 參考：《廣州中醫(yī)藥大學》2017年碩士論文

【摘要】：目的:通過對比研究手法整復結(jié)合改良克氏針內(nèi)固定術(shù)和切開復位鋼板螺釘內(nèi)固定術(shù)治療老年橈骨遠端骨折不穩(wěn)定型骨折的臨床療效,為老年橈骨遠端不穩(wěn)定型骨折治療方法的選擇提供臨床依據(jù)。方法:選取2015年3月～2016年9月深圳平樂骨傷科醫(yī)院老年橈骨遠端骨折患者60例,隨機將患者分為實驗組和對照組,每組30例,實驗組予手法整復結(jié)合改良克氏針內(nèi)固定術(shù),對照組予切開復位鋼板內(nèi)固定術(shù)。記錄兩組患者手術(shù)時間、術(shù)中出血量;兩組患者于術(shù)前、術(shù)后、術(shù)后6周、術(shù)后3個月拍攝X線片并測量掌傾角、尺偏角及橈側(cè)高度變化:采用視覺模擬疼痛評分(VAS)評價兩組患者術(shù)后當日、術(shù)后3天、術(shù)后1周、術(shù)后6周腕關(guān)節(jié)疼痛情況;采用Gartland-Werley腕關(guān)節(jié)評分評價兩組患者術(shù)后3個月、術(shù)后6個月的腕關(guān)節(jié)功能;記錄兩組患者術(shù)后不良反應發(fā)生情況、住院天數(shù)、治療費用及患者滿意度。采用統(tǒng)計學軟件SPSS 22.0對統(tǒng)計數(shù)據(jù)進行分析。結(jié)果:兩組患者基本資料比較,差異無統(tǒng)計學意義(P0.05)。實驗組手術(shù)時間及術(shù)中出血量明顯少于對照組,差異有統(tǒng)計學意義(P0.05);兩組患者之間的術(shù)后當日、術(shù)后3天、術(shù)后1周、術(shù)后6周VAS疼痛評分比較,術(shù)后當日、術(shù)后3天、術(shù)后1周VAS疼痛評分,差異均有統(tǒng)計學意義(P0.05),術(shù)后6周VAS疼痛評分,差異無統(tǒng)計學意義(P0.05);兩組患者之間的術(shù)前、術(shù)后、術(shù)后6周、術(shù)后3個月掌傾角比較,差異均無統(tǒng)計學意義(P0.05);兩組患者之間的術(shù)前、術(shù)后橈骨高度比較,差異均無統(tǒng)計學意義(P0.05),術(shù)后6周、術(shù)后3個月橈骨高度比較,差異均有統(tǒng)計學意義(P0.05);兩組患者之間的術(shù)前尺偏角比較,差異無統(tǒng)計學意義(P0.05),術(shù)后、術(shù)后6周、術(shù)后3個月尺偏角比較,差異均有統(tǒng)計學意義(P0.05);兩組患者術(shù)后3個月、術(shù)后6個月復查Gartland-Werley腕關(guān)節(jié)評分評價腕關(guān)節(jié)功能,術(shù)后3個月,實驗組和對照組的優(yōu)良率分別為66.67%、76.67%,差異無統(tǒng)計學意義(P0.05),術(shù)后6個月,實驗組和對照組的優(yōu)良率分別為83.33%、86.67%,,差異無統(tǒng)計學意義(P0.05);實驗組患者住院天數(shù)、治療費用均明顯低于對照組,差異有統(tǒng)計學意義(P0.05);實驗組和對照組的不良反應發(fā)生率分別為3.33%、10.00%,差異無統(tǒng)計學意義(P0.05);兩組患者術(shù)后3個月隨訪時主觀滿意度比較,實驗組和對照組的滿意率分別為93.33%、73.33%,差異無統(tǒng)計學意義(P0.05)。結(jié)論:兩種治療方式對于老年橈骨遠端骨折均有較好的臨床療效,在恢復掌傾角、尺偏角及橈骨高度方面,手法整復結(jié)合改良克氏針內(nèi)固定術(shù)低于切開復位鋼板螺釘內(nèi)固定術(shù),但是后期腕關(guān)節(jié)功能恢復無差異,且前者住院天數(shù)、治療費用均明顯低于后者,前者滿意度高于后者,綜合考慮老年人群的特殊生理階段,手法整復結(jié)合改良克氏針內(nèi)固定術(shù)治療橈骨遠端不穩(wěn)定型骨折更易被老年患者接受。
[Abstract]:Objective: to study the clinical effect of manual reduction combined with modified Kirschner needle fixation and open reduction plate screw fixation in the treatment of unstable fractures of distal radius in the elderly. To provide clinical basis for the treatment of unstable distal radius fractures in the elderly. Methods: from March 2015 to September 2016, 60 patients with distal radius fracture in Shenzhen Pingle Orthopedic and Trauma Hospital were randomly divided into experimental group and control group with 30 cases in each group. The experimental group was treated with manual reduction combined with modified Kirschner needle fixation. The control group was treated with open reduction and internal fixation with steel plate. The time of operation and blood loss during operation were recorded in both groups, and X-ray films were taken before operation, 6 weeks after operation and 3 months after operation, and the angle of palm inclination was measured. The changes of ulnar angle and radial height: visual analogue pain score (VAS) was used to evaluate the wrist joint pain on the same day, 3 days, 1 week and 6 weeks after operation, and Gartland-Werley wrist score was used to evaluate the postoperative 3 months. Wrist joint function 6 months after operation, adverse reactions, hospitalization days, treatment costs and patients' satisfaction were recorded in the two groups. The statistical data were analyzed by SPSS 22.0. Results: there was no significant difference in basic data between the two groups (P0.05). The time of operation and the amount of intraoperative bleeding in the experimental group were significantly less than those in the control group (P0.05); the VAS pain scores were compared between the two groups on the postoperative day, 3 days, 1 week, 6 weeks after operation, 3 days after operation and 6 weeks after operation. VAS pain score at 1 week after operation, the difference was statistically significant (P0.05), but there was no significant difference in VAS pain score at 6 weeks after operation (P0.05). There was no significant difference between the two groups (P0.05). There was no significant difference in the radial height between the two groups before and after operation (P0.05). The difference was statistically significant (P0.05), there was no significant difference in the preoperative ulnar deviation between the two groups (P0.05), the difference was statistically significant at 6 weeks and 3 months after operation (P0.05); 3 months after operation, there were significant differences between the two groups (P0.05). Six months after operation, Gartland-Werley wrist score was performed to evaluate wrist function. The excellent and good rates of the experimental group and the control group were 66.67 and 76.67, respectively. There was no significant difference between the two groups (P0.05), but at 6 months after operation, the excellent and good rates of the two groups were 66.67 and 76.67 respectively (P0.05). The excellent and good rates of the experimental group and the control group were 83.33 and 86.67, respectively, the difference was not statistically significant (P0.05); the days of hospitalization and the cost of treatment of the patients in the experimental group were significantly lower than those in the control group. The difference was statistically significant (P0.05); the incidence of adverse reactions in the experimental group and the control group were 3.33 and 10.00 respectively, the difference was not statistically significant (P0.05); the subjective satisfaction of the two groups was compared after 3 months follow-up. The satisfaction rates of the experimental group and the control group were 93.33 and 73.33, respectively. The difference was not statistically significant (P0.05). Conclusion: both methods have good clinical effect in the treatment of distal radius fracture in the elderly. In the recovery of palmar inclination angle, ulnar deviation angle and radius height, manual reduction combined with modified Kirschner needle internal fixation is lower than open reduction plate and screw fixation. But there was no difference in the recovery of wrist function in the later stage, and the days of hospitalization and the cost of treatment of the former were significantly lower than those of the latter, and the satisfaction of the former was higher than that of the latter. Manual reduction combined with modified Kirschner needle fixation for unstable distal radius fractures is more acceptable in elderly patients.
【學位授予單位】：廣州中醫(yī)藥大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R687.3

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