影响切开复位钢板内固定治疗桡骨远端骨折预后的相关因素分析

Analysis of correlative factors affecting the prognosis of distal radius fractures by open reduction and plate internal fixation

目的研究切开复位钢板内固定术治疗桡骨远端骨折的效果及其预后的影响因素。方法选择110例桡骨远端骨折患者,行切开复位钢板内固定术治疗,术后持续随访,术后3个月进行影像学和腕关节功能评分,分析临床及康复因素对预后的影响。结果影像学评分优47例(42.73%)、良30例(27.27%)、可21例(19.09%)、差12例(10.91%);Gartland&Werley腕关节功能评分优40例(36.36%)、良35例(31.82%)、可17例(15.45%)、差18例(16.36%)。术后3个月旋前恢复率最高,其次为尺偏、桡偏、掌屈、背伸、旋后。年龄≥60岁、AO分型复杂、合并同侧其他骨折、术中复位欠满意的患者术后影像学评分较差(P<0.05);年龄≥60岁、女性、AO分型复杂、合并同侧其他骨折、术中复位欠满意、术后开始锻炼时间的患者术后Gartland&Werley腕关节功能评分较差(P<0.05)。年龄、AO分型、合并同侧其他骨折为骨折复位的独立性危险因素(P<0.05);年龄、合并同侧其他骨折为功能恢复的独立性危险因素,术后开始锻炼时间为功能恢复独立性保护因素(P<0.05)。结论手术治疗桡骨远端骨折的复位及功能恢复预后受到年龄、合并骨折、骨折类型的影响,术后早期锻炼并不会影响骨折复位且可明显提高术后功能恢复效果。

Objective To study the effect of distal radius fractures by open reduction and plate internal fixation treatment and the factors affecting their prognosis. Methods The 110 patients with distal radius fractures were treated with the open reduction and plate internal fixation, and constantly followed up after the surgery, and assessed the imaging and wrist function score at 3 months after surgery, and the effects of clinical and rehabilitative factors on prognosis were analyzed. Results The imaging score results showed that there were excellent in 47 cases （42.73%）, good in 30 cases （27.27%）, fair in 21 cases （19.09%）, poor in 12 cases （10.91%）; the Gartland ＆ Werley wrist function score results showed that there were excellent in 40 cases （36.36%）, good in 35 cases （31.82%）, fair in 17 cases（15.45%）, poor in 18 cases（16.36%）. The recovery rate of pronation was the highest at 3 months after surgery, followed by ulnar deviation, radial deviation, palmar flexion, dorsiflexion, supination. The postoperative imaging scores were worse in patients with equal to or over 60 years of age, complex AO type, complicating with ipsilateral other fractures, less satisfactory intraoperative reduction （P〈0.05）; the postoperative Gartland ＆ Werley wrist function scores were worse in patients with equal to or over 60 years of age, female, complex AO type, complicating with ipsilateral other fractures, less satisfactory intraoperative reduction, postoperative exercise time （P 〈0.05 ）.The age, AO type, complicating with ipsilateral other fractures were the independent risk factors of fracture reduction （P〈0.05） ; The age and complicating with ipsilateral other fractures were the independent risk factors of functional recovery, postoperative exercise time was the independent protective factor of functional recovery （P〈0.05）. Conclusion The reduction and functional recovery prognosis of operation in the treatment of distal radius fractures are affected by the age, complicating fractures and type of fracture, and early postoperative exercise does not affect the fracture reduction and can significantly improve the postoperative functional recovery.