掌侧锁定加压钢板与外固定支架治疗不稳定桡骨远端C型骨折的比较研究

External fixator vs. volar locking compression plate fixation combined with Kapandji technique for unstable distal radial fractures of type C： a clinic study

目的比较研究掌侧锁定加压钢板（LCP）与外固定支架固定治疗不稳定桡骨远端C型骨折的疗效及适应证。方法2000年1月-2006年6月分别采用外固定支架和掌侧LCP结合克氏针撬拨、植骨等技术治疗不稳定桡骨远端C型骨折61例（85侧），骨折按AO／ASIF分型：C1型28侧，C2型33侧，C3型24侧。其中掌侧LCP治疗组34侧，外固定支架固定组51侧。比较两组手术前后掌倾角、尺偏角、桡骨短缩及关节活动范围等，初步评价其临床疗效。结果所有患者经6～27个月（平均16个月）随访。掌倾角、尺偏角、桡骨短缩及关节面均获明显改善。腕关节功能按Gartland—Werlev标准评定，C1、C2型骨折LCP组优于外固定支架组，差异有统计学意义（P〈0．05）；C3型骨折两组差异无统计学意义（P〉0．05）。结论对于掌侧或背侧不稳定的C1、C2型桡骨远端骨折，掌侧LCP可提供有效固定及早期活动；背侧不稳定的C型桡骨远端骨折是外固定支架的最佳适应证；严重粉碎的C3型骨折（尤其掌侧不稳定者）应联合运用LCP和外固定支架等技术。

Objective To compare external fixator and volar locking compression plate（LCP ） fixation combined with Kapandji technique for unstable distal radial fractures of type C. Methods Eighty-five cases of unstable distal radial fractures of type C were treated either with external fixator or volar LCP, combined with K-wiring and bone grafting. The effects were compared to analyze the volar tilt, radial inclination, radial shortening and wrist function. Results All the patients were followed up from 6 to 27 months （average, 16 months）. The volar tilt, radial inclination, radial shortening and wrist function were improved remarkably in all patients. According to Gartland-Werley scale, LCPgroup achieved better wrist function than external fixator group （P 〈0. 05） in type C1 and C2 fractures, while there was not statistical difference between the 2 groups in type C3 fractures. Conclusions Volar LCP fixation may offer effective stability for unstable （both volarly and dorsally displaced ） distal radial fractures of type C1 and C2, while the dorsally displaced （but not volarly displaced） and unstable distal radial fracture of type C are the optimal indication for external fixator. Combination of LCP and external fixator may be necessary for severe comminuted fractures of type C3, especially for the volarly displaced unstable fractures.