The Comparison And Analysis Of The Different Effect Between The Manual Reduction Therapy And Locking Plate Treatment For The Distal Radius Fracture By Applying The Three Column Theory

ObjectiveApplying the wrist joint three column theory for the replacement of the distal radius fracture, using the measurements of wrist joint function & X rays to explore the comparison of manual reduction maneuver combined with splint external fixation therapy & the LCP surgical therapy of the distal radius fractures, and analysis the curative effect and according to the statistic results, study the key point of the replacement of the distal radius fractures & study how the three column theory can improve the effect of the therapy of manual reduction maneuver combined with splint external fixation.MethodsAnalyze 110 distal radius fractures cases (91 cases successfully followed up) which had been diagnosed by X-ray examination and images we collected in our department from October 2013 to January 2015. Randomly allocate the patients into 2 groups, one is the research group, and one is the surgery group. Use the three column theory to clearly classified every patients of single column injury, double column injury or three column injury, and recheck X-ray and joint function after the treatment on day 1st, day 3rd, day 7th, day 14th, day 28th, day 1 month, day 2 month, day 3rd month, day 6th month. Using the statistical method to explore the relationship between three column theory and the two different therapies above.ResultsOn the overall comparison of the PRWE Joint function score,the score of the surgical group is lower than the experimental group on all stages, that means the joint function of surgical group is better than that of the experimental group, statistics of independent t test shows the results of the two groups on day 1st, day 3rd, day 7th, day 14th, day 28th, day 1 month, day 2 month, day 3rd month has significant differences (P<0.05), but without significant differences on day 6th month (P>0.05).On the X-ray evaluation, all the patients can be observed that the radiocarpal joint surface roughness were improved after treatment, and the surgical group had a better effect of maintaining. And all the patients’Ulnar Inclination Angle, joint surface height of the experimental group has not significant difference to the surgical group (P>0.05), the overall scores of palm inclination of curative effect is better than that of the experimental group(P<0.05)On the classification of three column theory, the experimental group is inferior to the surgical group in the comparison of the Joint function score for the patients with double column injury on day 1st, day 3rd, day 7th, day14 th,day 28 th,day1st month, day 2nd month, day 3rd month. The independent t test shows that there is significant differences between the two groups(P<0. 05). Whereas no significant difference there is found of the two groups on the day 6th month. Also the surgical group has a better Palm Angle effect to the experimental group on day1st day3rd day7th day 14th,day 28th, but later has no difference between the two groups. In the comparison of joint surface height & ulnar inclination, no obvious differences was found(P>0.05).In the comparison of three column injury, the joint function of the surgical group is superior to the experimental group on day 1st, day 3rd daynd,day 14th,day 28th,day1st month, day 2rd month, day 3nd month, day 6th month(P<0. 05) .And the surgical group also has a better effect on joint surface height,ulnar inclination Angle and palm angle in all stages(P<0. 05).ConclusionIn conclusion, we found that the closed reduction & external splint fixation therapy is superior to the surgical therapy in single column injury of the distal radius fractures, while the surgical therapy has a better effect in curing the three columns injury. And the surgical therapy also has a better effect in the early stages comparing to the closed replacement therapy in dealing with the double columns injury, but no differences between the two groups in the later period. Therefore, we believe that when dealing with the distal radius patients, we should chose the closed replacement & small splint external fixation treatment for the type of single column injury, and chose the surgical therapy for the type of three columns injury, and can chose either TCM therapy or surgical method for the type of double columns injury.