不同方法治疗桡骨远端C型骨折的疗效比较

Comparison of different treatment methods on the efficacy in distal radius type C fractures

目的比较应用外固定支架与锁定钢板内固定治疗桡骨远端C型骨折的疗效。方法 48例桡骨远端C型骨折的患者按手术方式不同分为外固定组（采用闭合复位外固定支架,24例）和内固定组（采用切开复位锁定钢板内固定,24例）,比较两组患者术中出血量、手术时间、住院时间、骨折愈合时间、术后腕关节功能。结果 48例获得随访,时间6～24（13.19±4.31）个月。术中出血量、手术时间、住院时间、骨折愈合时间外固定组均少（短）于内固定组,差异均有统计学意义（P〈0.05）。术后影像学在掌倾角、尺偏角：C1型骨折两种治疗方法比较差异无统计学意义（P〉0.05）;C2骨折内固定组优于外固定组,差异有统计学意义（P〈0.05）;C3型骨折外固定组优于内固定组,差异有统计学意义（P〈0.05）。结论外固定支架与锁定钢板内固定治疗桡骨远端骨折C型骨折均可获得良好的临床疗效。在术后24周影像学比较中：C2型骨折锁定钢板内固定治疗在影像学上有更好的掌倾角和尺偏角,更有利于关节功能恢复;C3型骨折外固定支架具有更好的牵张力,更能有效避免桡骨远端关节面继发性塌陷。外固定支架治疗创伤较小,有利于术后腕关节功能恢复。

Objective To compare the application of external fixation and locking plate internal fixation for the treatment of unstable distal radius type C fracture curative effect. Methods 48 cases of patients with type C distal radius fractures,according to different operation method,were divided into external fixation group（ 24 cases with closed reduction and external fixation support） and internal fixation group（ 24 cases with open reduction and internal fixation with locking plate）. Two groups of patients with intraoperative blood loss,operative time,hospitalization time,fracture healing time,postoperative comparative analysis on wrist joint function were compared. Results All patients were followed up for 6 ～ 24（ 13. 19 ± 4. 31） months. Two groups in blood loss,operative time,hospitalization time,fracture healing time,external fixation group were less than internal fixation group,the difference was statistically significant（ P〈0. 05）. Postoperative imaging in assessing the palmar inclination angle and ulnar deviation： the type C1 of distal radius fractures,two methods of treatment was no statistical difference（ P〉0. 05）; type C2 of distal radius fracture internal fixation group was superior to external fixation group,the difference was statistically significant（ P〈0. 05）; type C3 of distal radius fractures,external fixation group was obviously better than internal fixation group,the difference was statistically significant（ P〈0. 05）. Conclusions External fixation and plate fixation in treatment of distal radius fracture type C fractures can obtain good clinical curative effect. Imaging after 24 weeks in comparison：type C2 treatment on the imaging of the distal radius plate fixation is better palm tilt and ulnar deviation,is more advantageous to joint function recovery; C3 type of distal radius fractures,the external fixator has better tension,more can effectively avoid the radial distal articular surface secondary collapse. External fixation in treatment of distal radius fracture has small trauma and advantages of the wrist joint function.