[1]曹谦△,成勇峰,潘晓,等.杨氏旋后牵引法治疗成人移位尺桡骨双骨折87例[J].中国中医骨伤科杂志,2023,31(11):66-71.[doi:10.20085/j.cnki.issn1005-0205.231113]
　CAO Qian,CHENG Yongfeng,PAN Xiao,et al.Young's Supination Traction on the Treatment of 87 Adult Patients with Double Fracture of Displaced Ulna and Radius[J].Chinese Journal of Traditional Medical Traumatology & Orthopedics,2023,31(11):66-71.[doi:10.20085/j.cnki.issn1005-0205.231113]
点击复制

杨氏旋后牵引法治疗成人移位尺桡骨双骨折87例()
分享到：

《中国中医骨伤科杂志》[ISSN:1005-0205/CN:42-1340/R]

卷:
第31卷
期数:
2023年11期
页码:
66-71
栏目:
临床报道
出版日期:
2023-11-15

文章信息/Info

Title:
Young's Supination Traction on the Treatment of 87 Adult Patients with Double Fracture of Displaced Ulna and Radius
文章编号:
1005-0205(2023)11-0066-06
作者:
曹谦1△; 成勇峰1; 潘晓2; 曹慎1; 杨韵琴1
1湖南省湘潭市中医医院(湖南 湘潭,411100); 2湖南省湘潭市第二人民医院
Author(s):
CAO Qian1△; CHENG Yongfeng1; PAN Xiao2; CAO Shen1; YANG Yunqin1
1Xiangtan Chinese Medicine Hospital,Xiangtan 411100,Hunan China; 2The Second People's Hospital of Xiangtan,Xiangtan 411100,Hunan China.
关键词:
旋后牵引法;  尺桡骨双骨折;  非手术治疗;  小夹板
Keywords:
supination traction;  double fracture of radius and ulna;  nonsurgical treatment;  splint
分类号:
R683.41
DOI:
10.20085/j.cnki.issn1005-0205.231113
文献标志码:
B
摘要:
目的:探讨采用杨氏旋后牵引法整复、小夹板外固定治疗成人移位尺桡骨双骨折患者的临床疗效及安全性。方法:自2015年2月至2023年4月,采用杨氏旋后牵引法整复、小夹板外固定的方法治疗成人尺桡骨双骨折移位患者87例,男40例,女47例; 年龄为19～76岁,中位数为46.7岁; 病程为2.0～4.8个月,中位数为2.7个月。均为新鲜移位的尺桡骨双骨折成人患者,致伤原因为:交通意外伤9例,重物砸伤8例,平地滑倒64例,高处坠落伤6例。其中合并严重内科疾患者23例,合并有下尺桡关节脱位的患者4例,合并其他部位损伤的患者8例,尺骨或桡骨多段骨折的患者4例。采用杨氏旋后牵引法复位小夹板配合直角托板固定后,随访观察患肢疼痛缓解、骨折愈合时间、功能恢复及并发症发生情况。结果:83例患者获随访,4例患者失访,失访率为4.6%。固定后残留前后移位达1/3以上的患者24例,固定后残留侧方移位达1/2以上者12例,固定后残留侧方成角16例,固定后同时残留前后方及侧方移位者13例。随访时间为1.5个月～4年,中位数为2.9个月。采用疼痛视觉模拟量表评分,治疗前为(7.95±1.35)分,治疗中为(2.14±0.61)分,治疗后为(0.84±0.13)分; 平均愈合时间为(49.24±6.83)d; 前臂功能评估(Anderson评分)优75例,良7例,可1例,优良率达98.7%。3例患者在早期出现压疮,经处理痊愈。结论:杨氏旋后牵引法复位、小夹板外固定治疗成人移位尺桡骨双骨折,患者痛苦少,医生学习曲线短,前臂旋转功能恢复优良率高,骨折愈合时间短,并发症少,经济简便,疗效确切,但需要耐心细致地与患者及其家属沟通,取得理解和配合。总而言之,此项技术简单有效,特别适合合并严重内科疾患无法手术的患者,可在临床特别是基层医疗单位推广应用。
Abstract:
Objective:To investigate the clinical efficacy and safety of small splint external fixation with Young's supination traction on the treatment of adults with double fracture of displaced ulnar and radius.Methods:From February 2015 to April 2023,87 adult patients with displaced ulnar and radius double fractures(40 males and 47 females)were treated with small splint external fixation by Yang's supination traction method.Age ranged from 19 to 76 years old with 46.7 years old on average.The duration of the disease ranged from 2.0 to 4.8 months with a median of 2.7 months.All of them were adult patients with fresh displacement of both ulnar and radius fractures.The causes of injury were:traffic accident in 9 cases,heavy object injury in 8 cases,flat slip in 64 cases,falling from height in 6 cases.There were 23 patients with severe medical problems,4 patients with dislocation of the lower radioulnar joint,8 patients with other injuries,and 4 patients with multiple fractures of the ulna or radius.We followed up to observe the pain relief,fracture healing time,functional recovery and complications of the affected limb after restoration of the small splint with right angle bracket fixation by Young's supination traction method.Results:83 patients were followed up,4 patients were lost to follow-up,and the loss rate was 4.6%.There were 24 patients with more than 1/3 residual lateral displacement after fixation,12 patients with more than 1/2 residual lateral displacement after fixation,16 patients with residual lateral angle after fixation,and 13 patients with both anterior and posterior lateral displacement after fixation.The follow-up time was 1.5 months to 4 years with 2.9 months on average.The pain visual analogue scale was used to score before treatment(7.95±1.35)points,during treatment(2.14±0.61)points and after treatment(0.84±0.13)points.The mean healing time was(49.24±6.83)d.Forearm function assessment(Anderson score)was excellent in 75 cases,good in 7 cases and fair in 1 case,with an excellent and good rate of 98.7%.Three patients developed pressure ulcers in the early stage and recovered after treatment.Conclusion:Yang's supination traction method reduction small splint external fixation treatment of displaced adult double fracture of radius and ulna,patients with less pain,short learning curve of doctors,forearm rotation function recovery rate is high,fracture healing time is fast,fewer complications,economical and simple,accurate efficacy,but need patience and meticulous communication with patients and their families,understanding and cooperation,in a word,this technique is simple and effective.It is especially suitable for patients with severe medical diseases that cannot be operated on,and can be promoted and applied in clinical practice,especially in grass-roots units.

参考文献/References:

[1] 孙树椿.中医骨伤学高级教程[M].北京:中华医学电子音像出版社,2016:119.
[2] 蒲云清,谢进.特制蜜带预防骨折早期张力性水泡45例临床观察[J].中医药导报,2018,14(2):56-57.
[3] ANDERSON L D,SISK D,TOOMS R E.Compression-plate fixation in acute diaphyseal fractures of the radius and ulna[J].Journal of Bone & Joint,1975,57(3):287-297.
[4] MACDERMID J C,MCCLURE J A,RICHARD L,et al.Fracture profiles of a 4-sear cohort of 266,324 first incident upper extremity-fractures from population health data in Ontario[J].BMC Musculoskelet Disord,2021,22(1):1-16.
[5] 王恩波,张立军,李连永.再谈儿童骨创伤特殊性、提倡诊治专业化[J].中国骨与关节杂志,2020,9(3):161-163.
[6] CRENSHAW A J.Fractures of shoulder girdle,arm,and forearm[M]//in:CAMPBELL A H,ed.Campbell's operative orthopaedics.8th edtion.St Louis:Mosby Year Book,2008:1026-1029.
[7] BALDWIN K,MORRISON M J,TOMLINSON L A,et al.Both bone forearm fractures in children and adolescents,which fixation strategy is superior-plates or nails? A systematic review and meta-analysis of observational studies[J].J Orthop Trauma,2014,28(1):e8-e14.
[8] MULLER M E,NAZARAN S,KOCHPE D.Classfication Aodes fractures:LES longs[M].Berlin:Spinger-Verlag,2007:33.
[9] 朱通伯,戴尅戎,郭世绂,等.骨科手术学[M].2版.北京:人民卫生出版社,1999:301-308.
[10] 尚天裕.尚天裕医学文集[M].北京:中国科技出版社,1991.
[11] 张元民,王志彬.小夹板治疗骨折的微动观[J].中国骨伤,2000,13(12):18-19.
[12] KERSHAW C J,CUNNINGHAM J L,KEW RIGHT J.Tibial external fixation,weight bearing and fracture movement[J].Clin Orthop,1993,293:28-36.
[13] KASSIS B,GLORION C,TABIB W,et al.Callus response to micromovement after elongation in the rabbit[J].J Pediatr Orthop,1996,16(4):480-483.
[14] SARMIENTO A,MCKELLOP H A,LLINAS A,et al.Effect of loading and fracture motions on diaphyseal tibial fracture[J].J Orthop Res,1996,14(1):80-84.
[15] 向刚刚,曹鹏,吴若冰,等.“漂浮法”闭合复位治疗儿童尺桡骨双骨折的临床研究[J].中国中医骨伤科杂志,2023,31(4):51-55.
[16] 曹谦,曹慎,杨韵琴.旋后牵引手法整复小夹板外固定治疗移位儿童尺桡骨中段双骨折130例[J].中医药导报,2019,25(9):97-100.
[17] 李帮国,吴奇峰,付浩珂,等.孙氏正骨手法整复夹板外固定治疗儿童尺桡骨中下段双骨折40例总结[J].湖南中医杂志,2018,34(1):74-76.
[18] 郑占乐,刘家伦,张英泽.双反牵引微创治疗尺桡骨双骨折的初步临床应用[J].河北医科大学学报,2022,43(9):1085-1087.

备注/Memo

备注/Memo:
基金项目:湖南省中医药科技重点项目(2020024)
△通信作者 E-mail:172116099@qq.com
更新日期/Last Update: 2023-11-01