Jia Xue-Feng, Cai Hong-Xin, Lin Ge-Sheng, Fang Ji-Shi, Wang Yong, Wu Zhi-Yong, Tu Xu-Hui
The First People's Hospital of Wuyi, Wuyi 321200, Zhejiang, China;
Zhongguo Gu Shang. 2017 Jul 25;30(7):643-646. doi: 10.3969/j.issn.1003-0034.2017.07.012.
To investigate the effect of joint mobilization on postoperative wrist joint function, pain and grip strength for elderly patients with distal radius fracture.
From January 2015 to June 2016, a total of 67 elderly patients with distal radius fracture were randomly divided into routine exercise group and joint mobilization group. Among them, 37 patients in the routine exercise group underwent conventional distal radius fracture postoperative joint function exercise regimen, including 16 males and 21 females with a mean age of (67.8±3.2) years old ranging from 60 to 72 years old;the injured side was dominant in 23 cases and non-dominant in 14 cases;injury mechanism was fall in 26 cases, traffic accident in 11 cases; for AO type, 6 cases were type B3, 18 cases were type C1, 7 cases were type C2, 6 cases was type C3. Other 30 patients in the joint mobilization group underwent joint mobilization on the basis of the routine exercise group including 14 males and 16 females with a mean age of (67.1±4.0) years old ranging from 61 to 74 years old; the injured side was dominant in 21 cases and non-dominant in 9 cases;injury mechanism was fall in 25 cases, traffic accident in 5 cases;for AO type, 8 cases were type B3, 13 cases were type C1, 6 cases were type C2, 9 cases were type C3. The wrist joint activity, Gartland-Werley wrist joint function score, VAS pain score and grip strength were observed at 3 months afrer treatment.
After 3 months' treatment, the VAS in the routine exercise group was higher than that of the joint mobilization group (<0.05). The grip strength of affected side in both groups were lower than that of contralateral side, but the average grip strength of affected side in joint mobilization group was higher than that in routine exercise group(<0.05). In routine exercise group, the average angle of flexion, extension, radial deviation were significantly higher than those of joint mobilization group(<0.05). But ulnar deviation angle in routine exercise group compared with joint mobilization group had no significant difference (>0.05). In the comparison of each item of Gartland-Werley, there was no significant difference between two groups in residual deformity and complication(>0.05); the average score of subjective score, objective score and total score in routine exercise group were significantly higher than those of the joint mobilization group (<0.05). The wrist function Gartland-Werley score in routine exercise group after treatment was excellent in 21 cases, good in 10, 6 in fair, while in joint mobilization group, excellent in 23, good in 6, fair in 1(<0.05).
The application of joint mobilization in the treatment of elderly patients with distal radius fracture can improve the joint activity and obtain better wrist function after surgery.
探讨关节松动术对老年桡骨远端骨折患者术后腕关节功能、疼痛及握力的影响。
选取2015年1月至2016年6月期间67例老年桡骨远端骨折患者，随机分为常规锻炼组和关节松动组。其中，常规锻炼组37例患者接受常规桡骨远端骨折术后关节功能锻炼方案，包括男性16例，女性21例，平均年龄（67.8±3.2）岁，年龄范围60至72岁；患侧为优势手23例，非优势手14例；损伤机制为跌倒26例，交通事故11例；AO分型中，B3型6例，C1型18例，C2型7例，C3型6例。关节松动组30例患者在常规锻炼组基础上进行关节松动术，包括男性14例，女性16例，平均年龄（67.1±4.0）岁，年龄范围61至74岁；患侧为优势手21例，非优势手9例；损伤机制为跌倒25例，交通事故5例；AO分型中，B3型8例，C1型13例，C2型6例，C3型9例。治疗后3个月观察腕关节活动度、Gartland-Werley腕关节功能评分、VAS疼痛评分及握力。
治疗3个月后，常规锻炼组VAS评分高于关节松动组（<0.05）。两组患侧握力均低于对侧，但关节松动组患侧平均握力高于常规锻炼组（<0.05）。常规锻炼组的平均屈曲、伸展、桡偏角度显著高于关节松动组（<0.05）。但常规锻炼组尺偏角度与关节松动组相比无显著差异（>0.05）。在Gartland-Werley各项比较中，两组在残留畸形和并发症方面无显著差异（>0.05）；常规锻炼组主观评分、客观评分及总分的平均分显著高于关节松动组（<0.05）。常规锻炼组治疗后腕关节功能Gartland-Werley评分优21例，良10例，可６例，而关节松动组优23例，良6例，可1例（<0.05）。
关节松动术应用于老年桡骨远端骨折患者的治疗中，可改善关节活动度，术后获得更好的腕关节功能。
