钢板内固定与外固定架治疗桡骨远端C型骨折术后疗效比较

The efficacy comparison of postoperative fracture plate fixation and external fixator of AO type-C distal radial fractures

目的比较钢板内固定与外固定架治疗桡骨远端C型骨折术后的治疗效果。方法选择C型桡骨远端骨折患者61例,将其分为内固定组与外固定组。其中,内固定组32例,男15例,女17例,年龄22～67岁,平均（42.30±3.10）岁;按AO分型：C1型12例,C2型17例,C3型3例。外固定组29例,男13例,女16例;年龄24～66岁,平均（41.53±3.70）岁;按AO分型：C1型11例,C2型14例,C3型4例。采用腕关节活动度、X线片测量指标及GARTLAND-WERLEY评分进行综合评定。结果所有患者均获得随访,内固定组随访时间为12～30个月,平均（22.1±1.5）个月;外固定组12～36个月,平均（25.3±2.0）个月。X线片均显示两组骨折全部愈合。两组患者尺偏角、桡骨高度、腕关节背伸、掌屈、尺偏、桡偏、旋前、旋后等腕关节活动度及GARTLAND-WERLEY评分均无明显差异,比较差异无统计学意义（P〉0.05）。但内固定组掌倾角（12.05±3.01）°明显优于外固定组（7.05±2.90）°,比较差异具有统计学意义（t=6.377,P〈0.05）。内固定组并发症发生率（9.4%）明显小于外固定组（24.1%）,比较差异具有统计学意义（χ^2=7.580,P=0.006）。钢板内固定组伤口感染2例,正中神经损伤1例;外固定组钉道感染3例,固定松动2例,碗关节僵硬2例。结论钢板内固定与外固定架治疗桡骨远端骨折均可取得满意的疗效,钢板内固定固定可靠,未发生固定松弛现象,临床上可根据患者实际情况选择手术方式。

【Objective】To investigate the clinical effects of the plate fixation and external fixator in the treatment of the AO type-C distal radial fractures.【Methods】Sixty one patients of AO type-C distal radial fractures were divided into two groups： the internal fixation group（n =32） and the external fixation group（n =29）. Internal fixation group consisted of 32 patients, male 15 cases, female 17 cases, aged 22 to 67 years, mean（42.30 ±3.10） years. According to AO classifications, there were 12 type-C1, 17 type-C2, 3 type-C3. External fixation group consisted of29 patients, male 13 cases, female 16 cases, aged 24 to 66 years, mean（41.53±3.70） years. According to AO classifications, there were 11 type-C1, 14 type-C2, 4 type-C3, assessed by wrist activity, radiographic parameters and GARTLAND-WERLEY score. 【Results】All the patients were followed up. Internal fixation group was followed up for 12 to 30 months, mean（22.1 ±1.5） months. Internal fixation group was followed up for 12 to 36 months, mean（25.3 ±2.0） months. X-ray showed all fractures healed. Two groups of patients were ulnar deviation, radial height,wrist dorsiflexion, palmar flexion, ulnar deviation, radial deviation, pronation, supination of the wrist activity and Gartland-werley score did not differ significantly. The difference was not statistically significant（P〉0.05）. But the volar lilt was better in the internal fixation group（12.05±3.01） than in the external fixation group（7.05±2.90）. The difference was statistically significant（P〈0.05）.The complication rate of internal fixation group（9.4%） was significantly less than the external fixation group（24.1%）. There were 2 cases of wound infection, 1 case of median nerve injury in internal fixation group; 3 cases of pin tract infection, 2 cases of fixator loosening, and 2 cases of mist stiffness in the external fixation group.【Conclusion】Both the groups can achieve satisfactory clinical results. Fixed reliable fixation with plate and fixed relaxation did not occur. The choice of treatment method depends on the patient＇s clinical condition.