桡骨远端骨折掌背侧入路的疗效比较

Comparison between Volar and Dorsal Surgical Approaches for the Tretment of Fractures of Distal Radius

目的探讨掌背侧不同手术入路对治疗桡骨远端不稳定骨折的疗效影响。方法 2006年6月至2009年1月收治桡骨远端不稳定骨折患者62例,男29例,女33例;年龄20～76岁,平均51岁。损伤原因:摔伤38例,高处坠落伤14例,交通事故伤6例,运动伤4例。均为闭合新鲜骨折。按AO分类,B1型6例,B2型28例,B3型5例,C1型9例,C2型11例,C3型3例。随机分为两组,分别经腕掌侧(A组,n=43)及背侧(B组,n=19)入路行切开复位钢板内固定术。16例骨缺损破坏严重,行植骨填充。结果所有患者术后随访6～27个月,平均14个月,骨折均愈合。从骨折愈合时间、术后早期并发症、术后远期并发症、术后第24周腕关节功能恢复等方面比较两组差别。腕关节功能按Gartland-Werley计分法评价,A、B两组术后第24周腕关节功能优良率分别为88.4%和89.5%;放射学评价按Lid-strom评分标准评价,A、B两组桡骨关节面恢复优良率分别为94.1%和90.3%。A、B两组术后并发症比较,术后早期并发症差异无统计学意义(P>0.05),术后远期并发症差异有统计学意义(P<0.01)。结论掌背侧不同手术入路对治疗桡骨远端不稳定骨折的疗效有影响,各有优缺点,背侧入路钢板内固定术后远期并发症较多。

Objective To evaluate the outcome between volar and dorsal surgical approaches for the tretment of unstable fractures of distal radius.Methods From June 2006 to January 2009,62 cases with fracture of distal radius were treated,29 males and 33 females;aged 20 to 76 years（51years on average）.Among which 38 cases were caused by falls,14 cases falls injuries,6 cases of traffic accidents,and 4 cases sports injury.All cases were fresh closed fractures.According to AO,there were 6 cases for B1,28 for B2,5 for B3,9 for C1,11 for C2,and 3 for C3.All the cases were randomized into 2 groups：the wrist palmar group（group A,n=43） and dorsal group（group B,n=19）,to perform volar and dorsal plate fixation,respectively.Results All of the 62 cases were followed up for 6 to 27 months,an average of 14 months,all the fractures were healed.The two groups were compared from the following aspects：healing time,early complications and the wrist function after 24 weeks of operation.As for the wrist function by Cartland-Werley score Evaluation,the excellent rates of wrist function in Group A and Group B were 88.4% and 89.5% respctively at 24th week;As for radiological assessment by Lidstrom,the xcellent rates of radial articular surface restore were 94.1% and 90.3% respectively.With regard to comparison of postoperative complications between the two groups,there was no significant difference（P0.05） in early postoperative complications,but there was in long-term complications（P0.01）.Conclusion The volar and dorsal plate positions may offer effective stability for unstable distal radial fracture and early functional exercise.With advantages and disadvantages each,while the dorsal plate position may cause more complications in the long run.