Study On The Clinical Efficacy And Influence Factors Analysis Of Extension Distal Radius Fractures Treated By Combining Shih Traumatology Methods With Small Splint Fixation

Objective: To compare the clinical effects of Shih traumatology combined with small splint fixation group and Shih traumatology combined with plaster fixation group and open reduction and internal fixation group in the treatment of extensional fracture of distal radius,and to evaluate the therapeutic effect.At the same time,the related factors that influence the clinical effect of Shih traumatological manipulation combined with small splint fixation in the treatment of distal radius extension fracture were analyzed,and the basis for further optimizing the clinical treatment was provided.METHODS:1.From January 2018 to December 2018,patients with extended fracture of the distal radius were diagnosed in emergency department,outpatient department and inpatient department of Orthopaedics and traumatology department of Shanghai Yangpu District Hospital of Traditional Chinese Medicine.Parallel control design was used.45 patients in group A(small splint group)were treated with Shih traumatology technique combined with small splint fixation.Group B(gypsum group)40 cases: adopt Shih traumatology manipulation combined with gypsum fixation treatment.Group C(open reduction and internal fixation group)47 cases were treated with open reduction and plate internal fixation through volar approach.The palm inclination angle,ulnar deviation angle and radial shortening height were measured before treatment,after treatment and 1,2 and 6 weeks after treatment in group A,B and C.Three months later,Cooney wrist function scores of three groups were followed up to evaluate the therapeutic effect of the three groups.2.In order to further evaluate the factors affecting the curative effect of small splints,Cooney wrist function score of group A(small splint group)patients after three months was taken as dependent variable.Age,sex,BMI,fracture course,fracture type,angular displacement angle,palmar inclination angle,ulnar deviation angle,radial shortening height and fracture fixation time were taken as independent variables to do multiple linear regression analysis.Relevant factors of clinical efficacy of surgicalmanipulation combined with small splint fixation in the treatment of extended distal radius fractures.Result:1.There was significant difference in palmar inclination between groups at different follow-up time points.Small splint group and operation group could restore palmar inclination better.There was no significant difference in ulnar deviation between the three groups at each follow-up time point,and the three groups could recover the number of ulnar deviation better.The shortening height of radius was significantly different between groups at each follow-up time point,and the operation group could better restore the shortening height of radius.The overall excellent and good rate of Cooney wrist function score in three months was 93.6% in group C(open reduction and internal fixation group),86.7% in group A(small splint group),and 80% in group B(plaster group).In stratified study,the excellent and good rates of the three groups were100% in type A fracture,91.7% in group C(open reduction and internal fixation group),84.6% in group A(small splint group),58.3% in group B(plaster group),88.2% in group C(open reduction and internal fixation group),63.3% in group A(small splint group).Group B(gypsum group)57.1%.2.Multivariate linear regression equation was used to analyze the correlation between the curative effect of group A(small splint group).Results Age,sex,BMI,fracture duration,fracture type,angle of angular displacement,palmar inclination,ulnar deviation,time of fracture fixation had poor correlation(P > 0.05),and height of radial shortening had high correlation(P = 0.002 < 0.05).Conclusion:1.In AO classification of distal radius extension fracture,the effect of Shih traumatological manipulation combined with small splint fixation is similar to that of open reduction and internal fixation,and significantly higher than that of plaster fixation group.2.Shih palmar and ulnar deflections of patients with extended distal radius fractures can be restored better by the combination of traumatological manipulation and small splint fixation.3.The shortening height of radius before treatment has the greatest influence on the curative effect of Shih traumatological manipulation combined with small splintfixation in the treatment of patients with extension type of distal radius.4.Compared with plaster fixation and open reduction and internal fixation,small splint fixation has the lowest treatment cost.