可撑开及普通锁定加压钢板内固定修复老年骨质疏松性桡骨远端骨折:桡骨长度与腕关节功能恢复比较

Adjustable and ordinary locking compression plates for the repair of osteoporotic distal radius fractures: comparison of radial length and wrist function recovery

背景:运用锁定钢板修复骨质疏松性桡骨远端骨折已取得了良好的效果,但应用不同类型钢板内固定后桡骨远端相关解剖参数的变化仍不清楚。目的:通过与普通锁定加压钢板进行比较,探讨可撑开锁定加压钢板置入内固定对老年骨质疏松性桡骨远端骨折患者腕关节功能及桡骨长度恢复的修复效果。方法:对2012年1月至2014年1月南京中医药大学附属常州市中医医院骨科收拾的38例骨质疏松性桡骨远端骨折患者进行回顾性分析,根据内固定方案将患者分为两组,其中可撑开锁定钢板组22例,普通锁定钢板组16例,骨折分型采用AO分型,均采用掌侧入路。测量并对比两组患者术后及随访末X射线掌倾角、尺偏角、桡骨长度,根据Denis标准进行腕关节功能评估。结果与结论:所有病例均得到随访,随访时间5-26个月。患者均获得骨性愈合,愈合时间为9-16周,平均12.3周。内固定后两组掌倾角均值分别为10.6°和11.3°,尺偏角均值分别为21.1°和19.2°;随访末两组掌倾角均值分别为8.5°和8.5°,尺偏角均值分别为17.9°和15.8°,差异均无显著性意义(P>0.05)。内固定后两组桡骨短缩均值分别为0.5 mm和1.1 mm,随访末两组桡骨短缩均值分别为0.9 mm和1.4 mm,差异均有显著性意义(P<0.05)。内固定后Dienst功能评估:可撑开组优16例,良6例;普通组优11例,良5例,两组差异无显著性意义(P>0.05)。提示运用可撑开锁定加压钢板内固定修复老年骨质疏松性桡骨远端骨折能获得良好的术后掌倾角、尺偏角及腕关节功能,且其对桡骨长度的恢复较普通锁定加压钢板更好,并能在随访期间得到维持。

BACKGROUND： Locking compression plate in the treatment of osteoporotic distal radius fractures has achieved good results, but the changes in anatomic parameters of the distal radius after fixation with different kinds of plates remain unclear.OBJECTIVE： To investigate the clinical outcomes of the adjustable locking compression plate for treatment of osteoporotic distal radius fractures by comparing with the ordinary locking compression plate. METHODS： A total of 38 patients with osteoporotic distal radius fractures, who were treated in the Department of Orthopedics, Changzhou TCM Hospital Affiliated to Nanjing University of Traditional Chinese Medicine from January 2012 to January 2014, were retrospectively analyzed. According to the fixation schemes, the patients were divided into adjustable locking compression plate group（n=22） and ordinary locking compression plate group（n=16）. Fractures were assessed by the AO type, and all incisions were from palm side. The volar tilt, radial inclination, and radial length were recorded and compared between the two groups after surgery and during final follow-up. Wrist function was assessed according to Denis Standard. RESULTS AND CONCLUSION： All patients were followed up from 5-26 months. All the patients got bone union at an average of 12.3 weeks（range from 9-16 weeks）. The volar tilt was 10.6° and 11.3°, and the radial inclination was 21.1° and 19.2° in average instantly after operation, respectively in two groups. At the latest follow up, the volar tilt was 8.5° and 8.5°, and the radial inclination was 17.9° and 15.8° in average, respectively, which did not show significant differences（P 〉 0.05）. The radial shortening values were 0.5 mm and 1.1 mm instantly after operation in two groups. At the latest follow up, the radial shortening values were 0.9 mm and 1.4 mm during final follow-up in the two groups, which exhibited significant differences（P 〈 0.05）. According to Dienst assessment, in adjustable locking compression plate group, 16 cases were excellent, and 6 were good. In ordinary locking compression plate group, 11 cases were excellent, and 5 were good. There was no statistical difference between the two groups（P 〉 0.05）. These results confirmed that the adjustable locking compression plate can obtain good volar tilt, radial inclination and wrist function in treating the osteoporotic distal radius fractures. Compared to the ordinary locking compression plate, it has better restoration of the radial length, which can be maintained during the follow up.