中医正骨手法改善桡骨远端伸直型骨折患者腕关节功能的临床研究及疗效的影响因素分析

摘要 目的：观察中医正骨手法在桡骨远端伸直型骨折中的临床应用价值，并分析疗效的影响因素。方法：选择四川省骨科医院2020年1月~2022年1月期间收治的桡骨远端伸直型骨折患者152例，按照治疗方式的不同将患者分为对照组（给予石膏固定）和研究组（应用中医正骨手法治疗），例数分别为77例和75例。对比两组优良率、临床指标、腕关节活动度和X线相关影像学指标。同时采用多因素Logistic回归分析影响研究组腕关节功能疗效的相关因素。结果：治疗后，研究组的优良率明显高于对照组（P<0.05）。研究组手背消肿时间、疼痛缓解时间、骨折愈合时间均短于对照组（P<0.05）。两组治疗后12周掌屈、背伸、桡偏、尺偏、旋前、旋后活动度均扩大，且研究组均大于对照组（P<0.05）。两组治疗后12周掌倾角、尺偏角、桡骨高度均增加，且研究组均大于对照组（P<0.05）。单因素分析显示，研究组腕关节功能优良率与年龄、性别、骨质疏松、功能锻炼、掌倾角、尺偏角、桡骨高度、骨折端稳定性、受伤能量、利手情况有关（P<0.05），而与体质量指数、就诊时间、基础疾病、骨折类型、固定时间无关（P>0.05）。多因素Logistic回归分析显示：性别为女、骨质疏松、无功能锻炼、掌倾角偏小、桡骨高度偏短、骨折端不稳定、受伤能量为高能量、利手是影响腕关节功能优良率的危险因素（P<0.05）。结论：中医正骨手法可有效改善桡骨远端伸直型骨折患者腕关节功能，减少骨折愈合及疼痛缓解时间。此外，患者腕关节功能的优良率还受到性别、骨质疏松、功能锻炼、掌倾角、桡骨高度、骨折端稳定性、受伤能量、利手情况的影响，值得引起临床重视。

Clinical Study on Improving Wrist Function of Patients with Distal Radius Straight Fracture by Traditional Chinese Medicine Bone Setting Technique and Analysis of Influencing Factors of Curative Effect

ABSTRACT Objective: To observe the clinical application value of traditional Chinese medicine bone setting technique in distal radius straight fracture, and to analyze the influencing factors of curative effect. Methods: 152 patients with distal radius straight fracture who were admitted to our hospital from January 2020 to January 2022 were selected. According to different treatment methods, the patients were divided into the control group (given plaster fixation) and the study group (treated with traditional Chinese medicine bone setting technique), with 77 cases and 75 cases, respectively. The excellent and good rate, clinical indexes, wrist range of motion and X-ray related imaging indexes were compared in the two groups. Multivariate Logistic regression was used to analyze the related factors affecting the functional curative effect of the wrist. Results: After treatment, the excellent and good rate in the study group was significantly higher than that in the control group(P<0.05). The hand back detumescence time, pain relief time and fracture healing time in the study group were shorter than those in the control group (P<0.05). 12 weeks after treatment, palmarflexion, dorsiflexion, radial deviation, ulnar deviation, pronation and supination activity were expanded in the two groups, and the study group was greater than the control group (P<0.05). 12 weeks after treatment, palmar Angle, ulnar declination Angle and radius height were increased in the two groups, and the study group was greater than the control group(P<0.05). Univariate analysis showed that the excellent and good rate of wrist function in the study group was related to age, gender, osteoporosis, functional exercise, palmar Angle, ulnar declination Angle, radius height, fracture end stability, injury energy and handedness(P<0.05), but not related to body mass index, visit time, underlying disease, fracture type and fixation time(P>0.05). Multivariate Logistic regression analysis showed that gender with female, osteoporosis, non-functional exercise, small palmar Angle, short radius height, unstable fracture end, high energy of injury, handedness were the risk factors affecting the excellent and good rate of wrist function(P<0.05). Conclusion: Traditional Chinese medicine bone setting technique can effectively improve the wrist function of patients with distal radius straight fracture and reduce the time of fracture healing and pain relief. In addition, the excellent and good rate of wrist function of patients is also affected by gender, osteoporosis, functional exercise, palmar Angle, radius height, fracture stability, injured energy, handedness, which is worthy of clinical attention.