跨腕关节支撑钢板与外固定架治疗桡骨远端粉碎性骨折的临床研究

A clinical study on distraction plates and external fixator for treatment of distal radial comminuted fractures

目的比较跨腕关节支撑钢板与外固定架治疗桡骨远端粉碎性骨折的临床疗效。方法对自2007年7月~2010年6月收治的57例闭合性桡骨远端粉碎骨折（AO C2、C3型）采用跨腕关节钢板和外固定架进行治疗。结果术后12个月随访,两组桡骨茎突长度无统计学差异（P〉0.05）,关节面台阶有统计学差异（P〈0.05）。术后6、12个月随访时,两组间旋前、旋后、掌屈、背伸活动范围比较,无统计学差异（P〉0.05）。根据Jakim评分标准,两组优良率差异无统计学意义（P〉0.05）。外固定架组并发症发生率显著高于钢板组（P〈0.05）。结论①跨腕关节钢板和外固定架治疗桡骨远端粉碎骨折,骨折复位情况和临床治疗效果相当;②跨腕关节钢板固定手术创伤较大,但稳定性好,并发症较少;③跨腕关节钢板和外固定架结合克氏针固定后,可减少术后碎骨块再移位的可能性;④跨腕关节钢板固定治疗桡骨远端粉碎性骨折,骨折复位好,能保持骨折部的撑开以维持桡骨长度,防止短缩,可以取得较好的疗效。

Objective To evaluate the clinical results of patients with distal radial comminuted fractures treated with the technique of distraction plating and external fixator. Methods From July 2007 to June 2010, 57 patients with distal radial comminuted fractures（AO C2 and C3） were treated with the technique of distraction plating and external fixator. Results All patients were available for evaluation at a 12 months follow-up. There was no significant difference between the two groups in the length of radial styloid process （P 〉0.05）. The distraction plate group had more congruence articular surface than the external fixator group （P 〈0.05）. There was no significant difference between the two groups in the average wrist range of motion. Based on the Jakim score, there was no significant difference between the two groups in functional result （P 〉0.05）. The external fixator group had mole complications than the distraction plate group （P 〈0.05）. Conclusion （1）Those fractures fixed by distraction plate have analogue functional results and fracture restoration to by external fixator. （2）Those fi＇actm＇es fixed by distraction plate have more stability and less complications, although larger surgical trauma. （3）With K＇s wires, those fractures fixed by distraction plate and external fixator all can reduce the risk of re-displacement.（4）The technique of distraction plating allows for stable fixation, facilitates fracture reduction, reduces the risk of re-displacement, and has less complications in distal radial comminuted fractures.