| Objective:To observe the curative effect of traction manipulation plus plaster splint external fixation in the treatment of Smith III fracture,compare it with open reduction and internal fixation,summarize its advantages,so as to provide a reference basis for clinical decision-making of diagnosis in the future.Methods:From October 2020 to November 2021,56 patients with Smith III fracture who met the diagnosis and inclusion criteria in the reduction room of Tianjin Hospital and the Department of Orthopaedic Trauma of Tianjin Hospital were divided into traction and pressing manipulation plus plaster splint external fixation group(reduction group)and open reduction and internal fixation group(operation group).The reduction group(32 cases)was treated with traction lifting and manual reduction and plaster splint external fixation,and the operation group(24 cases)was treated with open reduction and internal fixation.Collation:1.The related data of radial styloid process height,ulnar deviation angle and metacarpal inclination angle of the two groups before treatment,after treatment,8 weeks and 12 weeks after treatment;2.VAS pain score before treatment,after treatment,8 weeks and 12 weeks after treatment;3.The X-ray grade of callus 8 weeks and 12 weeks after treatment;4.The modified Green and O’Brien wrist function scores and complications and the clinical healing time of the two groups were evaluated 12 weeks after treatment.All the data were analyzed by SPSS25.0 statistical software.Results:(1)Comparison of general information: A total of 56 patients were included in this study,including 14 males and 42 females.There were 32 cases(7 males and 25 females)in the reduction group and 24 cases(7 males and 17 females)in the operation group.The average age of patients in the reduction group was 56.81 ±12.27 years(30-71 years),and that in the operation group was 51.58 ±14.39 years(32-75 years).In the reduction group,there were 19 cases on the left side and 13 cases on the right side,while in the operation group,there were 16 cases on the left side and 8 cases on the right side.Before treatment,the height,ulnar deviation angle and metacarpal inclination angle of radial styloid process in the reduction group were5.23 ±1.15 mm,16.07 ±3.02 °and 19.01 ±5.48 °respectively,while those in the operation group were 5.22 ±1.29 mm,15.88 ±2.44 °and 19.58 ±4.05 °respectively.There was no significant difference in sex,age,distribution of affected limb,height of radial styloid process before treatment,ulnar deviation angle and metacarpal inclination angle between the two groups(P >0.05).(2)Comparison of VAS score: Comparison before and after treatment in the reduction group: compared with that before treatment,the VAS score in the reduction group decreased significantly after treatment,8 weeks and 12 weeks after treatment,and the difference was statistically significant(P<0.001).Comparison before and after treatment in the operation group: compared with before treatment,the VAS scores decreased significantly before treatment,after treatment,8 weeks and 12 weeks after treatment,and the difference was statistically significant(P<0.001).Comparison between groups: there was no significant difference in VAS score between the two groups before treatment(P>0.05),which was comparable.The VAS score of the reduction group improved more than that of the operation group after treatment,8 weeks and 12 weeks after treatment,and the difference was statistically significant(P<0.001).(3)Comparison of imaging indexes: compared with those before treatment,the height of radial styloid process,ulnar deviation angle and metacarpal inclination angle were significantly improved after treatment,8 weeks and 12 weeks after treatment,and the difference was statistically significant(P<0.001).Comparison in the operation group: the height of radial styloid process,ulnar deviation angle and metacarpal inclination angle were significantly improved after treatment,8 weeks and 12 weeks after treatment,and the difference was statistically significant(P<0.001).Comparison between groups: after treatment,8 weeks after treatment and 12 weeks after treatment,the height of radial styloid process,ulnar deviation angle and metacarpal inclination angle in the operation group were better than those in the operation group,and there was significant difference between the two groups(P<0.001).(4)Comparison of X-ray grade score of callus: at 8 weeks and 12 weeks after treatment,the X-ray grade score of callus in the reduction group was higher than that in the operation group,and the difference was statistically significant(P<0.001).(5)Comparison of clinical healing time: the clinical healing time was 11.21 ±0.93 weeks in the operation group and 8.06 ±0.98 weeks in the reduction group.The clinical healing time in the reduction group was better than that in the reduction group(P<0.05).(6)Comparison of modified Green and O’Brien functional score: 12 weeks after treatment,the functional score of the reduction group(90.93 ±5.56)was better than that of the operation group(85.63 ±5.78),and the difference was statistically significant(P < 0.05).The excellent and good rate of the reduction group was 96.87%,while that of the operation group was 91.66%.There was no significant difference between the two groups.(7)Comparison of complications after treatment: the incidence of complications was 12.5%in the reduction group and 20.8% in the operation group.There was no significant difference between the two groups.Conclusion:1.Traction and pressing manipulation combined with plaster splint external fixation and open reduction and internal fixation can achieve good clinical results in the treatment of Smith III fracture,and the wrist function of the patients can be well recovered.2.Traction and lifting manipulation combined with plaster splint external fixation was superior to open reduction and internal fixation in VAS score,callus X-ray score and clinical healing time,while open reduction and internal fixation could obtain better radius styloid process height,ulnar deviation angle and metacarpal inclination angle. |
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