摘要
目的探讨细化分型体系下不同类型Colles骨折的首次复位成功率、移位率,明确各分型的治疗重点,探索各分型的保守治疗策略。方法回顾性分析2022年1月至2024年12月收治的361例Colles骨折患者,按细化分型(4大型7亚型)分组,观察首次复位成功率、2周后移位率及术后参数变化,结合腕关节功能评分(Gartland-Werley)、视觉模拟疼痛量表(VAS)评分及活动度评估功能。结果Ⅰa型首次复位成功率最高(93.70%),Ⅲ型最低(16.67%);Ⅰb、Ⅱa、Ⅱb型移位率较高(33.33%~100.00%)。术后掌倾角异常患者腕背伸活动度显著降低(P<0.01),桡骨高度丢失>2 mm患者VAS评分明显升高(P<0.05)。不同分型的功能评分无显著差异(P>0.05),但解剖复位质量直接影响功能预后。结论Ⅰa型保守治疗成功率高,稳定性良好;Ⅰb、Ⅱa有一定复位成功率,但需密切观察后期移位情形,仍有保守治疗价值;Ⅲ型不建议保守治疗;Ⅳ型保守治疗与手术治疗最终参数差距大,但可能功能差异不大,暂不推荐治疗方案。不同类型骨折及不同治疗方式对后期功能影响较小,复位后不同解剖参数对功能影响较大,手法复位应重解剖参数恢复。
Objective:To explore the initial reduction success rate and displacement rate of different types of Colles fracture under a refined classification system,clarify the treatment priorities for each type,and explore conservative treatment strategies for each classification.Methods:A retrospective analysis was conducted on 361 patients with Colles fracture admitted from January 2022 to December 2024.The patients were grouped according to a refined classification system(4 main types and 7 subtypes).The initial reduction success rate,displacement rate at 2 weeks,and changes in postoperative parameters were observed.Functional differences were evaluated using the GartlandWerley wrist function score,Visual Analogue Scale(VAS)for pain,and joint range of motion measurements.Results:Type I a had the highest initial reduction success rate(93.70%),while TypeⅢI had the lowest(16.67%).Types I b,I a,and I b showed relatively high displacement rates(33.33%~100.00%).Patients with abnormal palmar tilt after surgery had a significant decrease in wrist dorsiflexion range of motion(P<0.01).Patients with radial height loss>2 mm had significantly higher VAS scores(P<0.05).There was no significant difference in functional scores among different types(P>0.05),but the quality of anatomical reduction directly affected functional prognosis.Conclusion:Type I a has a high success rate of conservative treatment with good stability.Types I b and I a have a certain reduction success rate,but require close observation of late displacement and still have conservative treatment value.Conservative treatment is not recommended for TypeⅢI.For Type IV,there is a large gap in final parameters between conservative and surgical treatment,but the functional difference may be insignificant,so the treatment plan is not recommended for the time being.Different fracture types and treatment methods have little impact on long-term function,while different anatomical parameters after reduction have a greater impact on function.Manipulative reduction should focus on the restoration of anatomical parameters.
作者
桂绍红
代云鑫
公孙婷
史岩
周永东
徐靖
杨昌国
Gui Shaohong;Dai Yunxin;Gongsun Ting;Shi Yan;Zhou Yongdong;Xu Jing;Yang Changguo(Shapingba District Hospital of Traditional Chinese Medicine,Chongqing 400030,China)
出处
《中国中医急症》
2026年第2期190-193,共4页
Journal of Emergency in Traditional Chinese Medicine
基金
重庆市科卫联合项目(2022MSXM194)。
关键词
COLLES骨折
分型
复位成功率
解剖参数
功能康复
Colles Fracture
Classification
Reduction success rate
Anatomical parameters
Functional rehabilitation
