两种方法在 Colles 骨折患者中的比较：一项实用、随机对照试验。
Two casting methods compared in patients with Colles' fracture: A pragmatic, randomized controlled trial.
机构信息
Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.
Department of Orthopaedics, Unit of Musculoskeletal Surgery, Tampere University Hospital, Tampere, Finland.
出版信息
PLoS One. 2020 May 29;15(5):e0232153. doi: 10.1371/journal.pone.0232153. eCollection 2020.
BACKGROUND
Distal radius fractures are common fractures and the cornerstone of treatment remains immobilization of the wrist in a cast. At present, there is a scarcity of studies that compare different cast immobilization methods. The objective of the study was therefore to compare volar-flexion and ulnar deviation cast to functional cast position in the treatment of dorsally displaced distal radius fracture among elderly patients.
METHODS AND FINDINGS
We performed a pragmatic, randomized, controlled trial in three emergency centers in Finland. After closed reduction of the fracture, the wrist was placed in either volar-flexion and ulnar deviation cast or functional cast position. The follow-up was 12 months. The primary outcome was patient-rated wrist evaluation (PRWE) score at 12 months. The secondary outcomes were Quick-DASH score, grip strength, health-related quality of life (15D), and pain catastrophizing scale. The number of complications was also recorded. In total, 105 participants were included in the study. Of these, 88% were female and the mean age was 73.5 (range 65-94) years. In the primary analysis, the mean difference in patient-rated wrist evaluation measure between groups was -4.9 (95% CI: -13.1.- 3.4., p = .24) in favor of the functional cast position. Operative treatment due to loss of reduction of fracture was performed for four patients (8%) in the FC group and for seven patients (13%) in the volar-flexion and ulnar deviation cast group (OR: 0.63, 95% CI: 0.16-2.1).
CONCLUSION
In this study, the data were consistent with a wide range of treatment effects when comparing two different cast positions in the treatment of distal radius fracture among elderly patients at 12-month follow-up. However, the functional cast is more likely to be superior when compared to volar-flexion and ulnar deviation cast.
TRIAL REGISTRATION
ClinicalTrials.gov identifier: NCT02894983 Accessible: https://clinicaltrials.gov/ct2/show/NCT02894983.
背景
桡骨远端骨折是常见的骨折，其治疗的基石仍然是将手腕用石膏固定在掌屈和尺偏位。目前，比较不同石膏固定方法的研究较少。因此，本研究的目的是比较掌屈和尺偏位石膏与功能位石膏在老年患者治疗背侧桡骨远端骨折中的效果。
方法和发现
我们在芬兰的三个急救中心进行了一项实用的、随机的、对照试验。骨折闭合复位后，将手腕置于掌屈和尺偏位石膏或功能位石膏中。随访时间为 12 个月。主要结局是患者手腕评估（PRWE）评分在 12 个月时的情况。次要结局包括 Quick-DASH 评分、握力、健康相关生活质量（15D）和疼痛灾难化量表。还记录了并发症的数量。共有 105 名参与者纳入研究。其中，88%为女性，平均年龄为 73.5（范围 65-94）岁。在主要分析中，两组间患者手腕评估测量的平均差异为-4.9（95%CI：-13.1.-3.4.，p=0.24），功能位石膏组更优。在 FC 组中，有 4 名（8%）患者因骨折复位丢失而进行手术治疗，而在掌屈和尺偏位石膏组中有 7 名（13%）患者（OR：0.63，95%CI：0.16-2.1）。
结论
在这项研究中，12 个月随访时，比较两种不同的石膏固定位置治疗老年桡骨远端骨折的疗效范围较广，但与掌屈和尺偏位石膏相比，功能位石膏更有优势。
试验注册
ClinicalTrials.gov 标识符：NCT02894983 可访问性：https://clinicaltrials.gov/ct2/show/NCT02894983。
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