Byl N N, Kohlhase W, Engel G
Graduate Program in Physical Therapy, School of Medicine, University of California-San Francisco, USA.
J Hand Ther. 1999 Jul-Sep;12(3):201-11. doi: 10.1016/s0894-1130(99)80047-7.
The majority of research on distal radius fractures consists of retrospective, descriptive studies of patients with unstable fractures requiring fixation. The purpose of this investigation was to report on impairments in flexibility, grip strength, and motor control and on the presence of swelling and atrophy immediately after cast immobilization of closed reductions of simple distal radius fractures. Sixteen adult subjects from Kaiser Permanente Medical Center, San Francisco, entered the study, and 13 completed it. At the initial evaluation, upper extremity ranges of motion, grip strength, forearm circumferences, two-point discrimination, and motor reaction times were measured on the uninvolved side. The same measurements were taken on the affected side within 48 hours after cast removal. All but one subject worked throughout the casting period. There were significant postcasting impairments in forearm rotation (40% deficit in pronation and supination); wrist flexion, extension, and radial and ulnar deviation (50% reduction in all motions); grip strength (-32 kg, or approximately 24% of the strength of the unaffected side); and forearm circumference (-1.1 cm) and wrist circumference (+1.5 cm). Patients complained of awkwardness of the involved hand. These measured impairments immediately after immobilization of simple radius fractures were greater than the reported impairments in patients after reduction of radius fractures with fixation 6 to 27 months after injury. To prevent long-term disability and recover flexibility, strength, and function, patients with simple distal radius fractures should be referred to a hand, occupational, or physical therapist for evaluation, education, and treatment after immobilization. Longitudinal studies are needed to quantify long-term functional recovery with regard to the type of fracture and the degree of impairment measured immediately after casting.
大多数关于桡骨远端骨折的研究都是对需要固定的不稳定骨折患者进行的回顾性描述性研究。本研究的目的是报告单纯桡骨远端骨折闭合复位石膏固定后立即出现的灵活性、握力和运动控制方面的损伤，以及肿胀和萎缩情况。来自旧金山凯撒永久医疗中心的16名成年受试者进入了该研究，13人完成了研究。在初始评估时，测量了未受伤侧的上肢活动范围、握力、前臂周长、两点辨别觉和运动反应时间。在拆除石膏后48小时内对受伤侧进行了相同的测量。除一名受试者外，所有受试者在整个石膏固定期间都在工作。石膏固定后存在明显的损伤，包括前臂旋转（旋前和旋后功能缺失40%）；腕关节屈伸、桡偏和尺偏（所有运动均减少50%）；握力（减少32千克，约为未受伤侧力量的24%）；前臂周长（减少1.1厘米）和腕部周长（增加1.5厘米）。患者抱怨患手活动不便。单纯桡骨骨折固定后立即出现的这些测量到的损伤大于报道的受伤后6至27个月进行桡骨骨折复位固定的患者的损伤。为防止长期残疾并恢复灵活性、力量和功能，单纯桡骨远端骨折患者在固定后应转诊至手部、职业或物理治疗师处进行评估、教育和治疗。需要进行纵向研究，以量化骨折类型和石膏固定后立即测量的损伤程度对长期功能恢复的影响。
