中国组织工程研究

中国组织工程研究 ›› 2019, Vol. 23 ›› Issue (22): 3469-3474.doi: 10.3969/j.issn.2095-4344.1752

• 组织工程骨及软骨材料 tissue-engineered bone and cartilage materials • 上一篇    下一篇

热塑板材支具外固定与石膏外固定治疗Colles骨折：随机对照试验

孔长庚，吴多庆，符林雄，黄友华，王琮仁
  

  1. 中南大学湘雅医学院附属海口医院骨科，海南省海口市  570208
  • 收稿日期:2019-03-06 出版日期:2019-08-08 发布日期:2021-04-28
  • 通讯作者: 吴多庆，副主任医师，中南大学湘雅医学院附属海口医院骨科，海南省海口市 570208
  • 作者简介:孔长庚，男，1977年生，湖南省长沙市人，主治医师，硕士，主要从事创伤骨科研究。
  • 基金资助:

    海南省自然科学基金项目(814379)，项目参与者：王琮仁；海口市重点科技计划项目(2014-081)，项目负责人：孔长庚  

External fixation of thermoplastic plate brace versus gypsum for treating Colles fracture: a randomized controlled trial

Kong Changgeng, Wu Duoqing, Fu Linxiong, Huang Youhua, Wang Congren
  

  1. Department of Orthopedics, Central South University Xiangya School of Medicine Affiliated Haikou Hospital, Haikou 570208, Hainan Province, China
  • Received:2019-03-06 Online:2019-08-08 Published:2021-04-28
  • Contact: Wu Duoqing, Associate chief physician, Department of Orthopedics, Central South University Xiangya School of Medicine Affiliated Haikou Hospital, Haikou 570208, Hainan Province, China
  • About author:Kong Changgeng, Master, Attending physician, Department of Orthopedics, Central South University Xiangya School of Medicine Affiliated Haikou Hospital, Haikou 570208, Hainan Province, China
  • Supported by:

    the Natural Science Foundation of Hainan Province, No. 814379 (to WCR); the Major Science and Technology Program of Haikou, No. 2014-081 (to KCG)

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摘要：

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文题释义：
Colles骨折：是指距桡骨远端关节面3 cm以内，骨折远端向桡、背侧移位，近端向掌侧移位的骨折，多为间接暴力引起。典型Colles骨折骨折体征包括：“银叉样”畸形(侧面看：骨折远端连同手部向背侧移位，其近侧有凹陷)、“枪刺样”畸形(正面看：骨折远端连同手部向桡侧移位，中指轴线与桡骨轴线不在同一平面)。
经典型高分子热塑板材：是一种由多己内酰酮制剂合成的高分子聚酯，经一系列物理和化学方法处理而成的新型的医用材料，可用于骨科外固定、矫形器、支具的制作材料。由于该材料具有厚度薄、质量轻、透气性好、不怕水、X射线通透性好、强度高、加热软化后具有良好的塑型效果和所特有的记忆功能等突出性能，是目前骨科临床理想的外固定材料。
 
 
背景：新型医用热塑板材支具已被广泛运用于四肢骨折外固定，并取得了一定的疗效，但其对需要手法复位桡骨远端骨折的疗效尚缺乏前瞻性随机对照研究。
目的：采用前瞻性随机对照方法比较手法闭合复位热塑板材支具与石膏外固定治疗Colles骨折的临床疗效。
方法：纳入中南大学湘雅医学院附属海口医院骨科2016年1月至2018年1月收治的120例Colles骨折患者，其中男52例，女68例，年龄18-65岁，按随机数分配表分为2组，分别进行手法闭合复位热塑板材支具外固定治疗(热塑板材组，n=60)与手法闭合复位石膏外固定治疗(石膏组，n=60)，记录治疗期间的并发症情况。治疗后3，6个月，应用目测类比评分评估疼痛情况；治疗后6个月，应用Gartland-Werley评分系统评估腕部功能，同时评估患者满意度；治疗后即刻、6周、6个月，影像学评估复位与骨折愈合情况。试验已获得经中南大学湘雅医学院附属海口医院伦理委员会批准，编号：2014(科研伦审)-308。
结果与结论：①热塑板材组材料宿主反应发生率低于石膏组(13.3%，36.7%，P < 0.05)；②热塑板材组治疗后3，6个月的目测类比评分均低于石膏组(P < 0.05)；③热塑板材组腕部功能优良率及患者满意度均高于石膏组(优良率：88.3%，73.3%；满意度：91.7%，65.0%，P < 0.05)；④影像学检查显示，两组治疗后6个月的桡骨高度、掌倾角、尺偏角均较治疗前明显改善，但两组间比较差异无显著性意义(P > 0.05)；⑤结果表明，采用热塑板材支具与石膏外固定治疗Colles骨折均可获得满意的复位效果，但热塑板材具有操作简便、并发症发生率低、腕部功能恢复好、患者满意度高的优势。

关键词: Colles骨折, 热塑板材, 石膏外固定, 支具外固定, 随机对照试验, 骨折, 并发症, 目测类比评分

Abstract:

BACKGROUND: The new medical thermoplastic plate brace has been widely used for the external fixation of limb fractures, and has achieved some curative effects. But there is still no prospective randomized controlled study on its efficacy in the distal radius fractures needing for manual reduction.
OBJECTIVE: To compare the clinical efficacy of manual closed reduction thermoplastic plate brace and gypsum external fixation in the treatment of Colles fracture by prospective randomized control.
METHODS: One hundred and twenty patients with Colles fractures from January 2016 to January 2018 at the Department of Orthopedics, Central South University Xiangya School of Medicine Affiliated Haikou Hospital were enrolled, including 52 males and 68 females, aged 18-65 years. The patients were randomly divided into two groups and treated with manual closed reduction and thermoplastic plate brace external fixation (thermoplastic plate group, n=60) and manual closed reduction gypsum external fixation (gypsum group, n=60). The complications during treatment were recorded. At 3 and 6 months after treatment, the Visual Analog Scale scores were assessed. At 6 months after treatment, the Gartland-Werley scoring system was used to assess the wrist function and to assess patient satisfaction. Imaging assessment of reduction and fracture healing was performed at immediately, 6 weeks and 6 months after treatment. The study was approved by the Ethics Committee of Central South University Xiangya School of Medicine Affiliated Haikou Hospital, approval number: 2014-308.
RESULTS AND CONCLUSION: (1) The incidence of reactions to the host in the thermoplastic plate group was lower than that in the gypsum group (13.3%, 36.7%, P < 0.05). (2) The Visual Analog Scale scores at 3 and 6 months after treatment in the thermoplastic plate group were lower than those in the gypsum group (P < 0.05). (3) The excellent rate of wrist function and patient satisfaction in the thermoplastic plate group were higher than those in the gypsum group (excellent rate: 88.3%, 73.3%; satisfaction: 91.7%, 65.0%, P < 0.05). (4) The imaging examination showed that the radial height, palmar tilt angle, and ulnar inclination angle in the two groups were significantly better than before treatment, and there was no significant difference between two groups (P > 0.05). (5) These results show that the use of thermoplastic plate brace and gypsum external fixation for treating Colles fracture can obtain satisfactory reduction effect, but the thermoplastic plate has the advantages of simple operation, low incidence of complications, good recovery of wrist function and high patient satisfaction.

Key words: Colles fracture, thermoplastic plate, external fixation of gypsum, external fixation of brace, randomized controlled trial, fracture, complications, Visual Analog Scale

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