臺灣博碩士論文加值系統

研究目的：本研究目的在於探討遠端橈骨骨折，使用互鎖式骨板與非互鎖式骨板內固定，手術後腕部功能恢復情形的差異性，以及其影響因素，以提供手術醫師和病患進行內固定骨板選擇的參考。
研究方法：本研究為回溯性研究，先經由病例查閱，調查2008年1月～2013年6月，於某中部地區醫院進行遠端橈骨骨折的病患，於其中挑選採用內固定骨板治療的病患，作為研究對象。篩選後總人數為164位，使用互鎖式骨板內固定為107人；非互鎖式骨板內固定為57人，於2013年11月～2014年1月，以自行設計問卷和上肢功能評估問卷(DISABILITIES OF THE ARM,SHOULDER AND HAND QUESTIONNAIRE, DASH)進行電訪，DASH分數越高表示失能嚴重度越高，依據DASH分數，以two-sample t-test、ANOVA分析不同變項間，手術後腕部功能恢復之差異性，採用互鎖式骨板與非互鎖式骨板，在各變項間分佈的差異性。以多變項線性迴歸模式，分析影響遠端橈骨骨折手術後腕部功能復原的相關因素。
研究結果：遠端橈骨骨折的女性病患比男性多22%，其中已停經婦女為多數，佔48.2%，依據雙變項分析結果，停經女性、70歲以上、低學歷者，手術後DASH分數最高，顯示其手術後的恢復情形最差，在控制其他變項下，採用互鎖式骨板進行遠端橈骨骨折復位的病患，於手術後腕部功能的恢復情形(DASH分數)比非互鎖式骨板好1.37倍，除了骨板的種類對術後腕部功能有顯著差異以外，本研究發現手術年齡與教育程度，也是影響手術後腕部功能恢復的因素，特別是在手術年齡60歲以上者，低學歷病患較高學歷病患在手術後，腕部功能恢復情形更差。
結論與建議：結論:遠端橈骨骨折病患中，停經女性、年齡70歲以上、低學歷者為術後腕部功能恢復情形最差，建議:(1)年齡大於60歲以上以及停經婦女，應宣導與鼓勵於每年進行骨質密度檢查，加強骨質疏鬆症防治和預防跌倒的知識，減少跌倒造成骨折的風險。(2)醫院應針對高齡的低學歷者，加強其手術後6個月內的自我照護能力，以增加術後腕部功能的恢復情形。(3)有骨質疏鬆或複雜性骨折的病患，在經濟條件許可下，可考慮使用互鎖式骨板進行遠端橈骨骨折手術。

Purpose: The purpose of this study is to investigate the comparison of locking plates and non-locking plates fixation in wrist functional recover for distal radius fractures. To provide surgeons and patients with distal radial fracture fixation bone plate reference is selected.
Method: This study was a retrospective study, the first inspection by the case, the investigation of the distal radial fracture patients in January 2008 - June 2013 in a particular hospital .Selection of the bone plate internal fixation patients as research subjects. After the screening of the total number of 164.107 people use of fixed locking plates; fixed non-locking plates of 57 people in November 2013 - January 2014, in order to design their own questionnaires and DISABILITIES OF THE ARM, SHOULDER AND HAND QUESTIONNAIRE(DASH) conducted telephone interviews, DASH scores higher the higher the severity of disability. According to the DASH scores, with two-sample t-test, ANOVA analysis between different variables, recovery of function after wrist surgery differences, using locking and non-locking plates , variable distribution among the differences. To analyze the relevant factors affecting the distal radial fracture after wrist surgery recovery function with Multiple Linear Regression.
Result: Distal radial fracture of female patients than men 22%, of which postmenopausal women for the majority(48.2%), based on bivariate analysis, postmenopausal women, 70 years or older, lower levels of education, post-operative DASH scores highest, showing its recovery after surgery the worst case, under the control of other variables, the use of locking plate wrist functional recover for distal radius fractures (DASH score) than non-locking bone plates good 1.37 times, in addition to the type of plates are significantly different than on postoperative wrist function, this study found that surgery age and educational level, factors that also affect functional recovery after wrist surgery, especially in the age at surgery exceed 60 years old , patients with low qualifications in higher education of patients after surgery, wrist functional recovery situation worse.
Conclusion and Recommendation: Conclusions: The patients with distal fractures in postmenopausal women, aged 70 years and older, lower levels of education for the functional recovery after wrist worst case. Recommended: (1) More than 60 years and postmenopausal women, advocacy and encouragement should be conducted annually in bone density, enhance the prevention and treatment of osteoporosis and fall prevention knowledge, reducing the risk of fractures caused by falls. (2) Hospitals should focus on lower levels of education for senior citizens, and enhance self-care abilities after their surgery within six months, in order to increase their recovery wrist function. (3) The complexity of patients with osteoporosis or fractures in the economic conditions permit, consider using locking bone plate Distal radius fracture surgery.

目 錄
第一章 緒論 1
第一節 研究動機 1
第二節 研究目的 3
第二章 文獻探討 4
第一節 遠端橈骨骨折類型與骨折型態 4
第二節 遠端橈骨骨折治療方式及相關研究 6
第三章 研究方法 12
第一節 研究對象與資料來源 12
第二節 統計分析方法 14
第三節 研究架構 16
第四章 研究結果 17
第五章 討論 27
第六章 結論與建議 30
參考文獻 32
附錄 1 問卷內容 36
附錄 2 專家名單 41
附錄 3 DASH問卷之IWH授權 42
附錄 4 DASH臺灣中文版之授權 43
附錄 5 亞洲大學醫學研究倫理委員會審查證明 44

表 目 錄
表 2-1 互鎖式骨板與非互鎖式骨板之比較 7
表 4-1 研究對象基本資料 20
表 4-2 研究對象健康行為 21
表 4-3 研究對象健康狀態 22
表 4-4 研究對象手術相關變項分佈 22
表 4-5 DASH分數雙變項分析 23
表 4-6 DASH分數迴歸分析 26

圖 目 錄
圖 2-1 Colles'fracture 5
圖 2-2 Colles'fracture X-ay 5
圖 2-3 Smith'farcture 5
圖 2-4 Smith'farcture X-ray 5
圖 2-5 Barton's fracture 5
圖 2-6 Barton's fracture X-ray 5
圖 2-7 橈、尺骨骨折型態 6
圖 2-8 互鎖式骨板與螺釘 8
圖 2-9 非互鎖式骨板與螺釘 9

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