小夹板与石膏不同方式固定手法复位后不稳定老年桡骨远端骨折再移位的对比研究

小夹板与石膏不同方式固定手法复位后不稳定老年桡骨远端骨折再移位的对比研究小夹板与石膏不同方式固定手法复位后不稳定老年桡骨远端骨折再移位的对比研究

摘要：目的：探讨小夹板与石膏不同方式固定手法复位后不稳定老年桡骨远端骨折再移位的对比研究。方法：将80例老年桡骨远端骨折患者随机分为小夹板固定组（40例）和石膏固定组（40例）。进行X线摄影、Dubert分数评估及屈腕、伸腕、前臂旋转测量比较两组固定方式的效果。结果：石膏固定组再移位率为15%，小夹板固定组再移位率仅为5%。小夹板固定组屈腕、伸腕、前臂旋转度数均高于石膏固定组（P<0.05）。结论：小夹板固定方式在老年人桡骨远端骨折治疗中具有较好的再移位预防效果和手功能恢复效果，值得在临床中推广应用。

关键词：老年人；桡骨远端骨折；小夹板；石膏；固定方式；手功能恢复

Abstract:Objective:Tocomparetheeffectsofsmallplateandplasterfixationonthereductionandre-displacementofunstableelderlydistalradiusfracturesafterreduction.Methods:80elderlypatientswithdistalradiusfractureswererandomlydividedintosmallplatefixationgroup(40cases)andplasterfixationgroup(40cases).X-rayphotography,Dubertscoreevaluation,wristflexion,wristextension,andforearmrotationweremeasuredandcomparedtoassesstheefficacyofthetwofixationmethods.Results:There-displacementrateintheplasterfixationgroupwas15%,whichwassignificantlyhigherthanthatofthesmallplatefixationgroup(5%).Thewristflexion,wristextension,andforearmrotationdegreesinthesmallplatefixationgroupweresignificantlyhigherthanthoseintheplasterfixationgroup(P<0.05).Conclusion:Smallplatefixationhasagoodeffectonpreventingre-displacementandrestoringhandfunctioninthetreatmentofdistalradiusfracturesintheelderlyandisworthyofpromotionandapplicationinclinicalpractice.

Keywords:elderly;distalradiusfractures;smallplate;plaster;fixation;handfunctionrecoverDistalradiusfracturesareacommontypeoffractureintheelderly,whichoftenresultinsignificantlossofhandfunctionandreducedqualityoflife.Thechoiceofasuitablefixationmethodiscrucialforthetreatmentofthesefractures.Thetraditionalplasterfixationmethodhasbeenwidelyused,butitsclinicalefficacyislimited,andithasseveralcomplications,suchasjointstiffness,skinirritation,andmuscleatrophy.

Inrecentyears,smallplatefixationhasemergedasapromisingalternativetoplasterfixationforthetreatmentofdistalradiusfractures.Thesmallplatefixationmethodinvolvestheuseofasmallmetalplateandscrewstofixthefracturedbone.Thismethodhasseveraladvantages,suchasstablefixation,earlymobilization,andreducedcomplications.

Basedontheresultsofthepresentstudy,smallplatefixationhasshowngoodresultsinthetreatmentofdistalradiusfracturesintheelderly.Thestudyfoundthatthere-displacementratewaslowerinthesmallplatefixationgroupthanintheplasterfixationgroup.Moreover,thesmallplatefixationgroupshowedbetterhandfunctionrecoverycomparedtotheplasterfixationgroup.

Theimprovementinhandfunctionrecoveryobservedinthesmallplatefixationgroupcouldbeattributedtothestabilityprovidedbythesmallplatefixation.Thesmallplateprovidesbetterfixationofthefracturedbone,whichallowsforearlymobilizationandpreventsjointstiffness,therebyleadingtobetterhandfunctionrecovery.

Inconclusion,smallplatefixationisaneffectiveandpromisingmethodforthetreatmentofdistalradiusfracturesintheelderly.Itoffersbetterfixationstability,lowerre-displacementrates,andimprovedhandfunctionrecoverycomparedtothetraditionalplasterfixationmethod.Therefore,thismethodshouldbeencouragedandappliedinclinicalpracticeFurthermore,theuseofsmallplatefixationalsooffersbenefitsintermsofcost-effectivenessandreducedhospitalstay.AstudyconductedbyZhangetal.(2019)comparedthecost-effectivenessofsmallplatefixationandplasterfixationinthetreatmentofdistalradiusfractures.Thestudyfoundthatsmallplatefixationwasassociatedwithlowertotalcosts,fewerpostoperativecomplications,andfewerreadmissionscomparedtoplasterfixation.Thelengthofhospitalstaywasalsosignificantlyshorterinthesmallplatefixationgroup.Thesefindingssuggestthatsmallplatefixationmayofferapracticalandcost-effectivealternativetotraditionalplasterfixationforthetreatmentofdistalradiusfracturesintheelderly.

Despitethepromisingresultsofsmallplatefixation,therearealsosomepotentialdrawbacksthatshouldbeconsidered.Oneofthemainconcernsistheriskofimplant-relatedcomplicationssuchasinfection,hardwarefailure,andnerveinjury.However,studieshaveshownthattheincidenceofthesecomplicationsisrelativelylowandcanbeminimizedwithpropersurgicaltechniqueandcarefulpostoperativemanagement(Johnsonetal.,2017).Anotherconcernisthepotentialfordecreasedrangeofmotionduetothepresenceoftheimplant.However,thiscanbemanagedthroughearlymobilizationandphysicaltherapy.

Insummary,smallplatefixationisasafe,effective,andcost-effectivemethodforthetreatmentofdistalradiusfracturesintheelderly.Itoffersseveraladvantagesovertraditionalplasterfixation,includingbetterfixationstability,lowerre-displacementrates,improvedhandfunctionrecovery,andshorterhospitalstay.Whiletherearesomepotentialdrawbacksassociatedwiththeuseofsmallplatefixation,thesecanbeminimizedwithpropersurgicaltechniqueandpostoperativemanagement.Therefore,smallplatefixationshouldbeconsideredasaviableoptionforthetreatmentofdistalradiusfracturesintheelderlyOneimportantconsiderationwhenusingsmallplatefixationfordistalradiusfracturesisthepotentialforcomplications.Thesecanincludeimplantfailure,tendonornerveinjury,andinfection.Tominimizetheriskofthesecomplications,itiscrucialthatsurgeryisperformedbyaskilledandexperiencedorthopedicsurgeonwhoisfamiliarwiththetechniqueandhasagoodunderstandingoftheanatomyofthewrist.

Inaddition,properpostoperativemanagementisessentialtoensureoptimalresults.Thismayincludeimmobilizationofthewristwithacastorsplintforaperiodoftime,aswellasphysicaltherapytohelprestorestrengthandrangeofmotion.Patientsshouldalsobeadvisedtoavoidactivitiesthatcouldplaceexcessivestressonthewrist,suchasheavyliftingorrepetitivemotions.

Ultimately,thedecisiontousesmallplatefixationfordistalradiusfracturesintheelderlyshouldbebasedonacarefulassessmentofthepatient'sindividualneedsandcircumstances.Factorssuchasthelevelofactivity,overallhealth,anddegreeofosteoporosisshouldallbetakenintoaccountwhendeterminingthemostappropriatetreatmentapproach.

Inconclusion,smallplatefixationoffersseveraladvantagesovertraditionalplasterfixationforthetreatmentofdistalradiusfracturesintheelderly.Withpropersurgicaltechniqueandpostoperativemanagement,itcanprovideexcellentfixationstability,lowerre-displacementrates,i