背景：3D 打印外固定支具能够针对骨折患者制定个体化的外固定方案并且佩戴方便，而伤科紫草油具有消肿化瘀辅助骨折康复治疗的功效，两者联合有利于骨折保守治疗患者的康复。

目的：评估3D 打印外固定支具联合伤科紫草油治疗桡骨远端骨折的临床效果，为寻求一种促进桡骨远端骨折后腕关节功能恢复的中西医结合治疗方案提供依据。

方法：纳入桡骨远端骨折患者64 例并随机分为2 组，试验组骨折手法整复后采用3D 打印外固定支具联合伤科紫草油治疗，对照组骨折手法整复后采用伤科紫草油联合常规夹板外固定治疗。比较2 组患者拆除外固定后2 周的Jakim 桡骨远端骨折疗效评分及其优良率，从疼痛程度、肿胀程度、腕关节活动范围、抓握能力、畸形程度方面进行评价。

结果与结论：①试验组疗效优良率为94%，对照组为78%，2 组间比较差异有显著性意义(P＜0.01)；②2组治疗后2，4，8，14 d 腕关节活动范围评分及目测类比评分均显著优于治疗前(P＜0.01)；治疗后不同时点，2 组间比较，试验组腕关节活动范围评分及目测类比评分均显著优于对照组(P＜0.05)；③治疗后2，4，8，14 d 的肿胀程度，试验组均优于对照组(P＜0.05)；④说明3D 打印外固定支具联合伤科紫草油治疗桡骨远端骨折效果确切，可有效改善患者腕关节功能，减轻患者痛苦，提升康复质量。

BACKGROUND:3D printing external fixation fixture can make individualized external fixation scheme for fracture patients and is easy to (a Chinese traditional medicine oil)for trauma treatment has the effect of reducing swelling and removing blood stasis to assist the rehabilitation treatment of combination of the two could benefit the rehabilitation of patients with fracture conservative treatment.

OBJECTIVE:To investigate the clinical application value of the 3D printed orthopedic cast combined withZicaooil in the treatment of distal radial fracture,hoping to provide a basis for the further study of a combined Chinese and western medicine treatment scheme for the recovery of wrist function after distal radius fractures.

METHODS:Sixty-four patients with distal radial fracture were selected and randomly divided into two in the trial group received 3D-printed cast combined withZicaooil treatment after manual in the control group received traditional splint cast combined withZicaooil after manual Jakim scoring for distal radial fracture treatment,as well as pain degree,swelling degree,wrist range of motion,grasping ability and deformity degree were evaluated and compared 2 weeks after removal of external fixation in both groups.

RESULTS AND CONCLUSION:(1)The excellent and good rate was 94%in the trial group and 78%in the control was significant difference between the two groups(P＜0.01).(2)At 2,4,8 and 14 days after treatment,the scores of wrist range of motion and visual analogue scale were significantly better than those before treatment(P＜0.01).At different time points after treatment,the scores of wrist range of motion and visual analogue scale in the trial group were significantly better than those in the control group(P＜0.05).(3)The swelling degree of the trial group was better than that of the control group 2,4,8 and 14 days after treatment(P＜0.05).(4)The results show that 3D printed cast combined withZicaooil is effective in the treatment of distal radius fracture,can effectively improve the function of wrist joint,reduce the pain of patients and improve the quality of rehabilitation.

0 引言 Introduction

桡骨远端骨折是最常见的上肢骨折之一，约占全身骨折类型的15%[1-2]，临床上对这类骨折的处理方法分切开复位钢板内固定手术治疗和手法复位夹板或石膏外固定保守治疗两大类[3-5]。保守治疗可减轻病患经济负担、精神负担以及防止手术创伤等，在临床治疗中为治疗的首选方案[4]。目前医院常用的保守治疗外固定材料有石膏和夹板，较石膏外固定而言，小夹板外固定可更好利用自身肌肉的静力作用，固定效果更为稳定可靠，并且有较好的透气性及可以早期功能锻炼，有利于愈合后关节功能的恢复[6]。但传统夹板外固定的缺点也很明显，主要有塑形性差，压力分布不均匀，无法做个性化固定，靠近关节的骨折固定稳定性较差，且夹板固定的松紧度由纱布缠绕打结来决定，肢体消肿后、患者活动后或更换敷料调整夹板后容易出现松动的情况[7]。

骨折后受伤部位周围肌肉、皮肤或黏膜等软组织由于出血和炎症等因素会出现软组织肿胀的情况，不利于骨折愈合，同时也增加相关并发症及感染的风险，故早期消肿是桡骨远端治疗的一项重要工作[8]。除常规抬高患肢、冷疗、增加临近关节活动这些消肿措施之外，药物敷料治疗也是促进早期消肿的重要措施。伤科紫草油(粤药制字Z)具有解毒消肿、活血化瘀的功效，对骨折后早期消肿具有显著疗效[9]。但在夹板外固定治疗骨折过程中使用伤科紫草油存在一些局限性，主要是因为伤科紫草油外敷需定期更换，传统夹板固定方法对术者手法要求高，且拆除重新固定步骤繁琐，操作不当易造成骨折移位，不利于敷料的更换。因此，寻求一种能个性化订制、拆装简便、材料塑型性好、舒适度高的外固定支具是解决问题的关键。

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