掌侧和背侧钢板内固定治疗背侧不稳定性桡骨远端骨折的病例对照研究

Case-control study on volar and dorsal plate for the treatment of dorsal unstable distal radius fractures

目的:探讨两种不同手术入路内固定方法对背侧不稳定性桡骨远端骨折的疗效。方法:收集2006年8月至2010年10月采用手术切开复位钢板内固定治疗,并获得随访的病例47例。男21例,女26例;年龄39～73岁。所有患者分为2组:采用掌侧入路掌侧钢板内固定(A组)32例,锁定钢板27例,普通"T"形钢板5例,其中4例联合应用背侧克氏针内固定;采用背侧钢板内固定(B组)15例,其中锁定钢板7例,普通"T"形钢板8例。术后从腕关节功能、X线评分及并发症等方面对掌侧和背侧钢板2种固定方法的疗效进行比较。结果:掌侧和背侧钢板固定术后1周与术前比较,掌倾角、尺偏角及桡骨茎突高度均明显改善;2组术后1周与术后半年比较,掌倾角、尺偏角及桡骨茎突高度均无明显丢失。术后A组正中神经牵拉伤1例,切口感染1例,肌腱粘连2例;B组切口红肿感染1例,肌腱粘连1例,拇长伸肌腱刺激3例;掌侧钢板内固定并发症的发生率低于背侧钢板内固定。腕关节功能评价:A组优17例,良11例,可3例,差1例;B组优8例,良4例,可2例,差1例;掌侧钢板内固定与背侧钢板内固定疗效无明显差异。结论:背侧移位的桡骨远端不稳定骨折,采用掌侧入路掌侧钢板内固定同样可以达到良好的复位效果,而肌腱损害等并发症较背侧钢板固定更少。

Objective ：To investigate the internal fixation methods in the two diiterent surgical approach to the unstable distal radius fractures. Methods：From August 2006 to October 2010,47 patients with distal radius fractures were treated with open reduction and plate internal fixation. Among the patients ,21 patients were male and 26 patients were female ,ranging in age from 39 to 73 years old. All the patients were divided into two groups：32 patients were treated with plate fixation at the palm side with palm side incision （group A） ,including locking plate used in 27 patients and ordinary T shape plate used in 5 patients; 15 patients were treated with dorsal plate fixation （group B）, including locking plate used in 7 patients and ordinary T shape plate used in 8 patients. The postoperative wrist function,X-ray score,complications were compared between the two groups. Results： Compare to preoperative, postoperative volar tih, ulnar deviation and radial styloid height of both groups im- proved ; and comparison between 1 week after operation and 6 months after operation,volar tilt,ulnar deviation and radial sty- loid height of both groups had no obvious loss. In group A, 1 patient had tension injury of median nerve, 1 patient had incision infection,2 patients had adhesion of tendon ; and in group B, 1 patient had incision swelling and infection, 1 patient had adhe- sion of tendon, 3 patients had stimulation of extensor pollicis longus muscle tendon. The complication occurrence rate of group A is lower than that of group B. The wrist functional assessment： 17 patients got an excellent results, 11 good, 3 poor and 1 bad in group A;and 8 excellent,4 good, 2 poor and 1 bad in group B. There was no statistically significant difference of wrist func- tion between the two groups. Conclusion： Plate fixation at the palm side for the treatment of unstable distal radius fractures can also achieve a good reduction, and has less complication such as tendon damage than that of dorsal plate fixation.