中医手法整复联合小夹板固定与手术治疗A型桡骨远端骨折的临床疗效比较分析OA

Objective To compare the clinical efficacy of traditional Chinese medicine(TCM)manipulative reduc-tion combined with small splint fixation versus surgical treatment for type A distal radius fracture(DRF)and to explore the factors influencing the choice of treatment.Methods A multi-center retrospective study was conducted,collecting data from 1237 type A DRF patients treated in 11 hospitals in Jiangsu province from September,2023 to April,2025.Among them,851 patients in the TCM group received manipulative reduction combined with small splint fixation,and 386 patients in the surgical group underwent open reduction and internal fixation.Visual analog scale(VAS)scores for pain and radiographic indicators including palmar tilt,ulnar deviation,and radial height were compared before treatment,5-7 days after treatment,and 4-6 weeks after treatment.The wrist joint function scores including Dienst and Gartland-Werley scores at 12 weeks after treatment were recorded.Subgroup analysis was con-ducted for the excellent rate of Dienst and Gartland-Werley scores,stratified by age(＜50,50-59,60-69,≥70 years old)and AO subtypes(A1,A2,A3).A multivariate logistic regression model was used to identify independent factors influencing treatment choice.Results On 5-7 days after treatment,the surgical group had lower VAS scores than the TCM group,while 4-6 weeks after treatment,the TCM group showed lower VAS scores than the surgical group(P＜0.01).In terms of radiographic indicators,except for the palmar tilt before treatment being higher in the surgical group than in the TCM group(P＜0.01),there were no significant differences in palmar tilt,ulnar devia-tion,and radial height at other timepoints(P＞0.05).Twelve weeks after treatment,the surgical group had a higher average Gartland-Werley score and the excellent rate than the TCM group(P＜0.01).Subgroup analysis showed that in patients with A2 type DRF aged 50-59 and 60-69 years old,the excellent rates of Dienst and Gartland-Werley scores in the TCM group were higher than those in the surgical group(P＜0.05).Multivariate logistic regression analysis revealed that age,palmar tilt,ulnar deviation,and the degree of swelling on the affected side were indepen-dent factors influencing the choice of treatment(P＜0.05).Conclusion Both TCM manipulative reduction combined with small splint fixation and surgical treatment for type A DRF can achieve good therapeutic effects.TCM manipulative reduction combined with small splint fixation has certain advantages in medium-and long-term pain relief,especially in elderly patients,where wrist joint function recovery is more stable.Age,palmar tilt,ulnar deviation,and swelling degree are the main factors influencing the treatment choice.