Chen Bo-Tao, Pan Sha, Yang Li
Department of Orthopaedics, Jiulongpo Hospital of Traditional Chinese Medicine, Chongqing 400080, China; Jiulongpo Hospital of Chongqing College of Traditional Chinese Medicine, Chongqing 400050, China.
Department of Ultrasound, Jiulongpo Hospital of Traditional Chinese Medicine, Chongqing 400080, China.
Zhongguo Gu Shang. 2024 Oct 25;37(10):953-8. doi: 10.12200/j.issn.1003-0034.20230850.
To observe the effects of groove splint fixation on early hand swelling, blood flow velocity, and clinical function in elderly patients with distal radius fractures.
Between March 2021 and February 2022, 64 patients of unilateral closed distal radius fractures were treated with manual reduction and external fixation with splints. There were 10 males and 54 females, the age ranged from 60 to 78 years old, with an average age of (67.7±4.7) years old. According to the order of admission, the patients were divided into the groove splint group and the conventional splint group, with 32 cases in each group. In the groove splint group, there were 4 males and 28 females, with an average age of (68.6±4.8) years old. There were 13 patients with left-sided fractures, and 19 patients with right-sided fractures, with 22 cases classified as AO type A and 10 cases as AO type C. The mean time from injury to treatment was 3.0 (2.0, 4.0) h. In the conventional splint group, there were 6 males and 26 females, with an average age of (66.9 ± 4.4) years old. There were 17 patients with left-sided fractures and 15 patients with right-sided fractures, with 20 cases classified as AO type A and 12 cases as AO type C. The mean time from injury to treatment was 3.0 (2.0, 5.0) h. After manual reduction, patients were treated with groove splint or conventional splint. Swelling, assessed by the difference in limb circumference between the injured and healthy limbs, was measured at 1, 3, 7, and 14 days post-treatment. Blood flow velocities in the superficial palmar arch and dorsal metacarpal veins were measured at 1, 3, and 7 days post-treatment. Radiographic evaluations of radial styloid height, palmar tilt, and ulnar variance were performed preoperatively and 3 months post-treatment. Functional outcomes were assessed using the DASH (Disabilities of the Arm, Shoulder, and Hand) score 3 and 12 months post-treatment. Statistical analyses were conducted to compare the outcomes between the two groups.
All 64 patients were followed up for the least 12 months. The swelling value of the palm in the groove splint group [(1.897±0.071) cm, (1.200±0.169) cm, (0.994±0.085) cm] was significantly improved compared to the conventional splint group[(2.283±0.268) cm, (1.893±0.269) cm, (1.183±0.126) cm] on days 3, 7, and 14 days posttreatment, with a statistically significant difference (<0.001). On the first and third day after splint fixation, the difference in blood flow velocity of the superficial palmar arch in the groove splint group(0.017±0.009), (0.018±0.011) L·min-1 were lower than that in the conventional splint group(0.023±0.011), (0.025±0.013) L·min-1, with statistical significance (<0.05). On the 3rd and 7th days, the difference was not statistically significant (>0.05). Comparison of blood flow velocity differences between the dorsal metacarpal vein and the two groups showed no statistically significant difference on the first day after splint fixation (>0.05). On the 3rd and 7th days, the blood flow velocity difference between the groove splint group[(0.037±0.019), (0.021±0.013) L·min-1] decreased compared to the conventional splint group[(0.062±0.033), (0.037±0.022) L·min-1], and the difference was statistically significant (<0.05). There was no statistically significant difference in the palm angle, ulnar deviation angle, and radius height of the distal radius before and after reduction (>0.05). The DASH score showed a statistically significant difference at follow-up 3-month[(6.1±2.8) scores vs (8.2±3.7) scores] , <0.05, but no statistically significant difference at follow-up 12-month (>0.05).
Fixing distal radius fractures with groove splints in the early stage can reduce the impact on the blood flow velocity of the superficial palmar arch and dorsal palmar vein, reduce venous reflux obstruction and swelling of injury limb, alleviate wrist and finger joint stiffness, and improve early clinical efficacy of the affected limb. However, it has no significant impact on clinical function one year after injury.
观察槽形夹板固定对老年桡骨远端骨折患者早期手部肿胀、血流速度及临床功能的影响。
2021年3月至2022年2月，64例单侧闭合性桡骨远端骨折患者采用手法复位及夹板外固定治疗。其中男性10例，女性54例，年龄60～78岁，平均年龄（67.7±4.7）岁。根据入院顺序，将患者分为槽形夹板组和传统夹板组，每组32例。槽形夹板组中，男性4例，女性28例，平均年龄（68.6±4.8）岁。左侧骨折13例，右侧骨折19例，AO分型中A型22例，C型10例。受伤至治疗的平均时间为3.0（2.0，4.0）h。传统夹板组中，男性6例，女性26例，平均年龄（66.9±4.4）岁。左侧骨折17例，右侧骨折15例，AO分型中A型20例，C型12例。受伤至治疗的平均时间为3.0（2.0，5.0）h。手法复位后，患者分别采用槽形夹板或传统夹板治疗。采用伤侧与健侧肢体周径差评估肿胀情况，于治疗后1、3、7及14天测量。于治疗后1、3及7天测量掌浅弓及掌背静脉血流速度。于术前及治疗后3个月对桡骨茎突高度、掌倾角及尺骨变异进行影像学评估。采用上肢、肩部和手部功能障碍（DASH）评分于治疗后3个月及12个月评估功能结局。进行统计学分析以比较两组结果。
64例患者均至少随访12个月。治疗后3、7及14天，槽形夹板组手掌肿胀值[（1.897±0.071）cm，（1.200±0.169）cm，（0.994±0.085）cm]较传统夹板组[（2.283±0.268）cm，（1.893±0.269）cm，（1.183±0.126）cm]明显改善，差异有统计学意义（<0.001）。夹板固定后第1天和第3天，槽形夹板组掌浅弓血流速度差值（0.017±0.009），（0.018±0.011）L·min-1低于传统夹板组（0.023±0.011），（0.025±0.013）L·min-1，差异有统计学意义（<0.05）。第3天和第7天，差异无统计学意义（>0.05）。夹板固定后第1天，两组掌背静脉血流速度差值比较差异无统计学意义（>0.05）。第3天和第7天，槽形夹板组掌背静脉血流速度差值[（0.037±0.019），（0.021±0.013）L·min-1]较传统夹板组[（0.062±0.033），（0.037±0.022）L·min-1]降低，差异有统计学意义（<0.05）。复位前后桡骨远端的掌倾角、尺偏角及桡骨高度差异无统计学意义（>0.05）。DASH评分在随访3个月时差异有统计学意义[（（6.1±2.8）分对（8.2±3.7）分]，<0.05，但随访12个月时差异无统计学意义（>0.05）。
早期采用槽形夹板固定桡骨远端骨折可减轻对掌浅弓及掌背静脉血流速度影响，减少伤肢静脉回流障碍及肿胀，缓解腕关节及手指关节僵硬，提高患肢早期临床疗效。但对伤后1年临床功能无明显影响。
