外固定支架术与切开复位钢板内固定术治疗不稳定型桡骨远端骨折的效果及对患者疼痛评分的影响比较

Comparison of the effects of external fixator and open reduction and internal fixation in the treatment of unstable distal radius fractures and its influence on pain score

目的比较外固定支架术与切开复位钢板内固定术对不稳定型桡骨远端骨折治疗效果及患者疼痛评分的影响。方法选入2012年3月至2016年3月首都医科大学附属北京友谊医院平谷医院收治的不稳定桡骨远端骨折患者100例,根据不同治疗方式分为外固定组(n=50)和内固定组(n=50),外固定组采用外固定支架术,内固定组采用切开复位钢板内固定术,比较两组临床疗效及对患者疼痛评分的影响。结果术后3个月、12个月:内固定组患者的关节面台阶分别为(2.35±0.42)mm、(0.93±0.4)6mm,均明显低于外固定组的(2.99±0.38)mm、(1.41±0.57)mm,组间差异均有统计学意义(t=7.990,4.634,P=0.000,0.000);内固定组患者的掌倾角分别为(12.66±1.40)°、(13.32±1.74)°,均明显高于外固定组的(9.66±1.87)°、(11.35±1.94)°,组间差异均有统计学意义(t=9.081、5.345,P=0.000、0.000);内固定组患者的尺偏角分别为(23.89±1.67)°、(24.81±2.02)°,均明显高于外固定组的(21.59±1.94)°、(22.91±2.32)°,组间差异均有统计学意义(t=6.353、4.367,P=0.000、0.000);内固定组患者的桡骨高度分别为(10.23±0.38)mm、(11.45±0.42)mm,均明显高于外固定组的(9.77±0.36)mm、(10.89±0.43)mm,组间差异均有统计学意义(t=6.214、6.588,P=0.000、0.000)。内固定组与外固定组的腕关节功能恢复优良率分别为82.0%、74.0%,组间比较差异无有统计学意义(χ^2=0.932,P=0.334);外固定组术后1d、3d的疼痛(VAS)评分分别为(4.35±0.35)分、(2.10±0.46)分,均低于内固定组的(5.46±0.71)分、(3.12±0.56)分,组间差异均有统计学意义(t=9.860、9.952,P=0.000、0.000);两组均未发生骨折不愈合的情况,外固定组患者临床愈合时间为(9.10±1.13)周,明显短于内固定组的(10.85±1.77)周,组间差异有统计学意义(t=5.893,P=0.000)。结论切开复位钢板内固定的复位效果优于外固定支架法,而外固定支架法可有效减轻患者术后疼痛程度,有利于骨折愈合。建议临床根据患者骨折类型及具体情况选择个性化治疗方案。

Objective To compare the effects of external fixator and open reduction and internal fixation on unstable distal radius fractures and the influence on pain score.Methods From March 2012 to March 2016,100 cases of unstable distal radius fractures admitted in Pinggu Hospital Affiliated to Capital Medical University were selected in this research.According to different treatment,the patients were divided into external fixed group (n=50) and internal fixation group (n=50). The external fixation group was treated with external fixator,and the internal fixation group was treated by open reduction and plate fixation. The clinical efficacy of the two groups and their effect on pain score were compared.Results At 3 months,12 months after operation,the articular surface steps in the internal fixation group were (2.35±0.42)mm and (0.93±0.46)mm,respectively,which were significantly lower than those of the external fixation group [(2.99±0.38)mm,(1.41±0.57)mm],and the differences were statistically significant (t=7.990,4.634,P=0.000,0.000). The palmar inclination in the internal fixation group were (12.66±1.40)° and (13.32±1.74)°,respectively,which were significantly higher than those of the external fixation group[(9.66±1.87)°,(11.35±1.94)°],and the differences were statistically significant (t=9.081,5.345,P=0.000,0.000). The ulnar deviation angle in the internal fixation group were (23.89±1.67)° and (24.81±2.02)°,respectively,which were significantly higher than those of the external fixation group [(21.59±1.94)°,(22.91±2.32)°],and the differences were statistically significant (t=6.353,4.367,P=0.000,0.000). The radial height in the internal fixation group were (10.23±0.38)mm,(11.45±0.42)mm,respectively,which were significantly higher than those of the external fixation group [(9.77±0.36)mm,(10.89±0.43)mm],and the differences were statistically significant (t=6.214,6.588,P=0.000,0.000). The excellent and good rate of wrist function recovery in the internal fixation group and the external fixation group was 82% and 74%,respectively.There was no statistically significant difference between the two groups (χ^2=0.932,P=0.334). At 1 day,3 days after operation,the VAS scores of the external fixation group were (4.35±0.35)points and (2.10±0.46)points,respectively,which were lower than those of the internal fixation group [(5.46±0.71)points,(3.12±0.56)points],the differences between the two groups were statistically significant (t=9.860,9.952,P=0.000,0.000). No fracture nonunion occurred in the two groups.The clinical healing time of the external fixation group was (9.10±1.13) weeks,which was significantly shorter than that of the internal fixation group [(10.85±1.77) weeks],and there was statistically significant difference between the two groups (t=5.893,P=0.000).Conclusion The reduction effect of open reduction and plate fixation is better than external fixator,external fixator can effectively relieve postoperative pain and accelerate fracture healing.It is suggested that individualized treatment should be selected according to the fracture type and specific circumstances.