外固定支架结合经皮穿针固定治疗桡骨远端粉碎性骨折

External Fixation Combined with Percutaneous Pin Fixation for the Treatment of Comminuted Fracture of Distal Radius

目的探讨外固定支架结合经皮穿针固定治疗桡骨远端粉碎性骨折的临床疗效。方法采用外固定支架结合经皮穿针固定治疗桡骨远端粉碎性骨折病人32例,与同期行单纯钢板内固定治疗的32例患者进行回顾性病例对照研究。结果两组患者均恢复顺利,未发现外固定支架松动、骨折断端移位、钉道感染、肌腱损伤、关节炎等并发症。64例均获得随访,随访时间7.3(2～18)个月,所有患者均在6～8周X线显示骨折处明显骨痂形成,骨小梁通过骨折线后拆除外固定支架。术后掌倾角、尺倾角及桡骨轴向短缩长度较术前有明显改善(P<0.05),术前、术后组间各数据比较均无统计学差异(P>0.05)。根据改良Mcbride评分和纽约骨科医院腕关节评估标准(1990年),外固定组优15例、良14例、可3例,优良率90.6%;钢板组优12例、良14例、可6例,优良率81.2%;组间优良率比较无统计学差异(P>0.05)。结论外固定支架结合经皮穿针固定治疗桡骨远端复杂性、粉碎性骨折具有操作简单,并发症少,复位效果好的优点,具有明显临床推广价值。

Objective To explore the clinical curative effect of external fixators combined with percutaneous pinning treatment for the fractures of distal radius.Methods 32 cases of comminuted fractures of distal radius underwent the external fixation combined with percutaneous pinning treatment.Their clinical data was retrospectively analyzed with the other 32 cases that were treated with plate internal fixation at the corresponding period.Results All the 64 cases received follow-up for 7.3（2~18） months,and were clearly showed a fracture callus formation with trabecular bone through the fracture lines at 6~8 weeks after operation.Postoperative ulnar deviation angle,the palmar deviation angle and the crispation length got obviously improved（P0.05）.According to the modified McBride scores and the New York orthopaedic hospital criteria for wrist（1990）,there were excellent of 15 cases,good of 14 cases and fair of 3 cases,with a good rate of 90.6% in the external fixation group and excellent of 12 cases,good of 14 cases and fair of 6 cases,with a good rate of 81.2% in the plate group（P0.05）.Conclusions It is recommended of obvious clinical promotional value of the external fixators combined with percutaneous pin fixation for the treatment of distal radius comminuted fracture with the advantages of easier operation,fewer complications and better reduction effects.