掌侧锁定钢板联合背侧钛网治疗桡骨远端粉碎性骨折

Volar locking compression plate plus dorsal SynMesh in the treatment of distal radius comminuted fracture

目的比较掌侧锁定钢板与掌侧锁定钢板联合背侧钛网内固定治疗的桡骨远端粉碎性骨折的疗效。方法57例（65侧）桡骨远端粉碎性骨折患者，根据治疗方法分为锁定钢板固定组（对照组）31例（35侧）和掌侧锁定钢板联合背侧钛网内固定组（钛网组）26例（30侧），比较两组术后桡骨远端掌倾角、尺偏角、桡骨远端相对长度以及腕关节功能评分。结果57例均得到随访，时间8～24（15．7±6．34）个月。影像学结果显示骨折均愈合。对照组桡骨远端掌倾角9°～17°（12．91°±2．16°），尺偏角19°～26°（22．60°±1．80°），桡骨远端相对长度0．9～1．6（1．27±0．18）cm；钛网组桡骨远端掌倾角9°-16°（12．93°±1．89°），尺偏角19°-26°（22．07°±1．84°），桡骨远端相对长度0．9～1．6（1．20±0．19）cm；两组比较差异无统计学意义（P〉0．05），两组分别与参考值比较差异均无统计学意义（P〉0．05）。末次随访时腕关节功能采用Fernandez标准评分：对照组优7侧，良22侧，可4侧，差2侧，优良率82．8％；钛网组优16侧，良11侧，可2侧，差1侧，优良率90．0％，两组比较差异有统计学意义（P〈0．05）。结论掌侧锁定钢板联合背侧钛网内固定治疗桡骨远端粉碎性骨折术后患者腕关节功能恢复效果优于单纯锁定钢板内固定。

Objective To compare the clinical results of volar locking compression plate （LCP） and volar LCP plus dorsal SynMesh in the treatment of distal radius comminuted fracture. Methods 57 patients with 65 distal radius comminuted fractures were managed and divided into two groups. Control group were treated by volar LCP（ 31 cases, 35 sides） and SynMesh group were treated by volar LCP plus dorsal SynMesh（26 cases,30 sides）. Results All pa- tients were followed up for 8 -24 （ 15.7 ±6. 34） months. All paiticnts were bone healed assessing by X-ray. All the X-rays were measured after operations. Control group ： palmar inclination was 9° - 17° （ 12.91° ± 2. 16° ） , ulnar de- viation was 19°- 26°（22. 60°± 1.80°） , relative length of radius was 0.9 - 1.6 （ 1.27± 0. 18 ）cm; SynMesh group： palmar inclination was 9°-16°（ 12. 93°± 1.89°） , ulnar deviation was 19° -26° （22.07° ±1.84°）, relative length of radius was O. 9 - 1.6（ 1.20 ±0. 19） cm; the differences between both groups were no statistically significant （P 〉 O. 05） , and so did between groups and the reference value （P 〉0. 05） , too. According to Fernandez＇s criteria, the wrist joint function in control group was excellent in 7 cases, good in 22, fair in 4, poor in 2 and excellent-good rate was 82.8%. The wrist joint function in SynMesh group was excellent in 16 cases,good in 11, fair in 2,poor in 1 and excellent-good rate was 90%. The difference was statistically significant between the two groups （P 〈 0. 05 ）. Conclu- sions Volar LCP plus dorsal SynMesh may result in better results than volar LCP for distal radius comminuted frac- ture in wrist joint function recovery.