老年C_3型桡骨远端骨折两种手术治疗方法疗效观察

Clinical observation on the effects of two different treatments for elderly patients with type C_3 distal radius fracture

目的探讨不同治疗方法在老年C3型桡骨远端骨折手术患者中的疗效差异。方法本研究选自我院2008年10月至2010年10月收入的46例桡骨远端累及关节面的C3型骨折患者。根据治疗方式不同分为钢板内固定组(23例)及外固定支架组(23例),术后患者进行随访,其中腕关节恢复情况采用Dienst腕关节功能评分标准评估。术后行X线片观察患者掌倾角、尺偏角、桡骨短缩及关节面台阶恢复情况。结果所有患者进行10～18个月随访,平均12.4个月。其中内固定组1例术后内固定松动,外固定组1例关节僵硬。两组患者术后掌倾角、尺偏角、桡骨短缩及关节面台阶与术前对比差异有统计学意义(P<0.05)。两组患者术后疗效对比显示,内固定组优良率(86.9%)显著高于外固定组的优良率(69.5%),差异有统计学意义(P<0.05)。结论切开复位T形钢板内固定及外固定架均可以用于C3型骨折的治疗中,T形钢板内固定相对疗效更佳。

Objective To investigate the effect of two different methods in the treatment of type C3 distal radius fracture in elderly patients.Methods Forty-six patients of type C3 distal radius fracture were selected in our hospital from October 2008 to October 2010.The patients were divided into two groups according to different treatments：the internal fixation group（n=23） and the external fixation group（23 cases）.All the patients were followed up after treatment.The recovery of wrist joint was evaluated by Dienst functional evaluation standards.The palmar tilt,radial inclination,radial shortening and articular surface level were observed by postoperative radiographs.Results All the patients were followed up for 10～18 months,with a mean of 12.4 months.One patient in the internal fixation group suffered postoperative internal fixation loosening,and one in the external fixation group suffered joint stiffness.The palmar tilt,radial inclination,radial shortening and articular surface level after treatment showed statistically significant difference with those before treatment,P0.05.The excellent and good rate in the internal fixation group（86.9%） was significantly higher than that in the external fixation group（69.5%）,P0.05.Conclusion Open reduction,T plate internal fixation,and external fixator can all be used in the treatment of type C3 fractures,of which T plate internal fixation is relatively more effective.