钢板与外固定架治疗桡骨远端不稳定骨折的疗效分析

Plate Osteosynthesis Versus External Fixation Device for Unstable Distal Radius Fractures:A Clinic Therapeutic Effect Analysis

目的探讨钢板内固定与外固定架治疗桡骨远端不稳定骨折的临床疗效。方法回顾性分析2004年10月～2008年10月期间应用钢板与外固定架固定治疗62例桡骨远端不稳定骨折的临床疗效。其中切开复位钢板内固定27例(钢板组),闭合性骨折23例,开放性骨折4例;骨折按AO分型:B型17例,C型10例。平均手术时间86 min(60～120 min),术中应用止血带,术后前臂石膏托制动3周后活动腕关节功能锻炼。闭合复位外固定架35例(支架组),闭合性骨折28例,开放性骨折7例;骨折按AO分型:B型21例,C型14例。平均手术时间52 min(35～80 min)。术后8～12周根据骨折愈合情况拆除外固定支架活动腕关节。结果所有病人均获得随访,平均随访时间8个月(6～18个月)。两组患者在骨性愈合时间,掌倾角、尺偏角、桡骨短缩及关节面恢复情况无明显差异。3个月随访时钢板组腕关节屈曲、背伸、桡偏活动度及Gartland-Werley功能评分优于支架组,差异有统计学意义(P<0.05),6个月随访时差异无统计学意义。结论钢板内固定对早期恢复腕关节活动度方面优于外固定架,但长期临床疗效两者无明显的差异,桡骨远端不稳定骨折应根据具体的情况选择合适的固定方式。

Objective To compare the clinic therapeutic outcomes of plate osteosynthesis and external fixation device for unstable distal radius fractures.Methods Sixty-two unstable distal radius fractures were treated either with open reduction volar plate internal fixation（n=27） or indirect reduction external fixation（n=35） from October 2004 to October 2008.The clinic outcomes were analyzed by radiographic alignment,wrist range of movement and wrist function.Results All patients were followed up from 6 to 18 months（average 8 months）.At the three months those with volar plate internal fixation had significantly more wrist flexion,extension,radial deviation and Gartland-Werley score compared with patients with external fixation device.The other range of movement did not differ significantly between the two groups.After six months there was no statistically significant difference in wrist range of movement and Gartland-Werley score in the two groups.Conclusion Plate internal fixation can confer earlier recovery of function for unstable distal radius fractures.In long-term follow-up,there is no evidence to support the use internal fixation over external fixaton device for unstable distal radius fractures.