| The purpose of treatment of distal radius fracture is to obtain a good postoperative appearance,painless functional activity and no complications.Because of the special structure of the wrist joint,the radius has an average 23 degrees(23.6+2.5)ulnar deviation and an 11 degrees(11.2+4.6)palmar inclination in the distal articular surface.Angle deviation and radius shortening are easy to occur after fracture.This is the anatomical index pursued by the treatment,and is also the key to achieve the goal of treatment.Good recovery of angle and height is an important objective of treatment of distal radius fracture.It is reported that the ulnar load will increase from 21%to 67%in the process of radial articular surface tilting from 10 palm to 45 dorsal extension.It will cause discomfort of triangular fibrocartilage and wrist joint,and cause abnormal rotation of radial wrist joint.Once the angle of distal radius can not be corrected effectively,it is difficult to guide and encourage patients to perform functional exercises.At the same time,it may lead to aggravation of the degree of injury when doing functional exercises.In addition,the severe comminution of the distal radius articular surface in type C distal radius fracture further increases the difficulty of restoring the anatomical angle of radius,and increases the possibility of further injury during functional exercise.Distal radius fracture accounts for about 15%of adult fracture.It is one of the most common injuries in emerency orthopaedic department.Type C distal radius fracture accounts for 25%of distal radius fracture.Its treatment consumption occupies an important proportion in the expenditure of the medical system,and at the same time increases the cost of family life.At the same time,with the import and rapid development of modern western surgical technology,the proportion of internal fixation for fracture treatment is increasing year by year,and the proportion of traditional Chinese medicine characteristics is gradually compressed.However,the current trend of overuse of surgical treatment,and the need for second surgery after fracture healing removal of internal fixation will lead to increased medical costs,patients with increased financial burden.Some patients have a natural sense of fear and panic about surgical treatment,which also increases the psychological burden of patients on the basis of physical trauma.Our predecessors Shang Tianyu small splint and Meng and external fixator have achieved brilliant results in the treatment of fractures,which provide valuable experience for the study of new methods of bone reduction and external fixator in the treatment of distal radius fractures.The treatment of distal radius fracture with Monteggia external fixator is simple,inexpensive and efficient,which is the flash point of Chinese medicine bone injury.However,due to the limitations of the era and the experience inheritance mode of traditional Chinese medicine,its treatment method still remains in the form of "experience" handed down orally,and its characteristics and advantages lack scientific and systematic interpretation and clarification.With the development of the times and the improvement of the treatment methods,some ideas of the treatment methods need to be renewed and replaced.Based on the above situation,the most urgent task for the majority of medical workers of bone injuries in traditional Chinese medicine is to innovate on the basis of inheritance and make it carry forward.Most of the conclusions are that internal fixation has advantages over external fixation in restoring palmar inclination angle.Literature reports that external fixator has only axial traction force in the fixation of radius fracture,and can not achieve stable lateral fixation.Therefore,angular displacement of fracture site can not be effectively corrected,especially for complex displacement of type C fracture,because closed reduction is difficult to obtain good anatomical index number.According to.Our hospital has abundant clinical experience and accumulation in the treatment of common fractures with external fixation of traditional Chinese medicine.We have succeeded our predecessors Shang Tianyu small splint and Meng and external fixator in the treatment of fractures and achieved brilliant results.Following the ancient precepts of "making instruments correctly,not catching them with auxiliary techniques" and the experience of previous bone-setting techniques,the application of traditional Chinese medicine "tendons and bones" and modern external fixation technology has taken root and sprouted in our hospital.Based on the above situation,we inherit and innovate the traditional fracture external fixation methods,and develop a new semi-ring external fixator for the treatment of distal radius.Compared with single arm external fixator and rod external fixator,semi-ring external fixator can penetrate the contralateral cortex and increase the stability of the overall plane.At the same time,the semi-ring external fixator can be combined freely again on the basis of the existence of semi-ring structure.The thick needle made of metal(Kirschner wire can also be substituted)is inserted into the joint space or fracture space of dislocation.The dislocation or displaced fracture end can be reduced by prizing,driving,pushing,spinning,dividing,closing,pressing and pulling.It conforms to the therapeutic concept of "laying equal stress on both muscles and bones,and giving consideration to both internal and external factors" of bone injuries in traditional Chinese medicine.Through clinical observation,the effect of semi-circular external fixator combined with pin-piercing reduction and fixation of distal radius type C fracture is satisfactory.Compared with the operation of internal fixation of distal radius only,the recovery effect of palmar inclination angle of distal radius is better under the condition of guaranteeing the function of affected limbs.In view of this,it is proposed to use semi-ring external fixator combined with pin reduction and open reduction plate and screw internal fixation,analysis and internal fixation compared with semi-ring external fixator combined with pin reduction can achieve better anatomical angle recovery and better functional recovery in the treatment.At the same time,in the treatment of different types of fractures and different needle piercing methods of the relationship between summary,mining the relationship between each other,and further open up ideas.To explore the method of combining external fixator with small splint in order to provide a new reference for clinical treatment of distal radius fracture,and to provide a basis for standardized diagnosis and treatment of distal radius fracture with fixator.1 Research purposesThe clinical and non-randomized controlled study of the group design of the C-type distal-end fracture of the bone fracture in the clinic was compared.The short-term curative effect and the long-term function recovery of the distal fracture of the C-type bone fracture were treated by the combination of the semi-ring type external fixation support and the needle-penetrating reduction fixation,and the treatment effect of the semi-ring type external fixation support combined with the puncture needle reduction on the fracture of the type was also observed.2 Research objects and methods64 cases of distal radius fracture treated and matched from June 2016 to June 2018 were selected for clinical observation.The patients treated with semi-ring external fixator combined with pin reduction were included in the experimental group,and those treated with plate and screw internal fixation of distal radius were included in the control group.According to the same sex,similar age and fracture type,matching requirements:same sex,similar age,the same type of distal radius fracture.According to the calculation formula of sample size,32 pairs(64 cases)of matching and follow-up observation were completed,including 12 pairs of C1 type fracture,12 pairs of C2 type fracture and 8 pairs of C3 type fracture.The minimum follow-up time was 1 year and the average follow-up time was 16 months.The perioperative indexes were compared and the wrist function was evaluated by Garland-Werley score.The imaging scores of the two groups were compared and the subjective activity of affected limbs was evaluated at the last follow-up.3 ResultsThe minimum follow-up time of the two groups was 1 year,and the average follow-up time was 16 months.The experimental group had the shortest operation time of 30 minutes,the longest 90 minutes,the average 55 minutes,no bleeding volume in the skin incision was less than 10 ml,no drainage strip was placed,and the average number of X-ray exposure was 20 times.There was no slippage of fixed needle and infection in the experimental group.Except for 1 case of inferior ulnar-radial fusion,1 case of radial nerve dorsal branch irritation when protruding bending forceps were prying reduction,1 case of malunion of fracture occurred when reduction and fixation were not good,which affected the appearance,and no delayed union or nonunion of fracture was observed.According to Gartland-Werley Wrist Joint Score,the excellent and good rate of the experimental group was 87.5%,and that of the control group was 87.5%.Wrist Joint Function Score was not statistically significant(P>0.05).There was no statistical significance in wrist radial-ulnar deviation activity and hand grip strength between the two groups(P>0.05).There was statistical significance in wrist dorsal extension and flexion activity and pronation and supination activity between the two groups(P<0.05).The excellent and good rate was 78.2%in the experimental group and 81.2%in the control group.Both groups were effective before treatment,after operation and at the last follow-up(P<0.05),and no reduction loss occurred after operation compared with the last follow-up(P>0.05).There was significant difference in palmar inclination data between the two groups after operation and the last follow-up(P<0.05),and there was no significant difference in the other two groups.4 ConclusionWhen treating comminuted distal radius fracture,semi-ring external fixator can take into account both functional and anatomical recovery,especially for palmar inclination recovery,which has obvious clinical advantages.However,due to its needle piercing method still stays in the experience stage,it needs to be further summarized,sublimated and improved. |
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