桡骨远端关节内简单骨折非手术与切开复位内固定治疗的比较

Comparison of conservative treatment and open reduction with plate fixation for simple intra-articular distal radius fractures

目的比较桡骨远端关节内简单骨折采用闭合复位石膏外固定(CRPF)和切开复位内固定(ORIF)治疗的疗效。方法回顾性分析自2011-10—2013-10采用闭合复位石膏外固定及切开复位内固定治疗56例桡骨远端关节内简单骨折的临床资料。对以下指标进行比较:腕关节活动度、影像学测量数值、腕关节患者自行评估(Patient-Rated Wrist Evaluation,PRWE)评分、并发症和再手术情况。结果所有骨折均愈合,ORIF组平均愈合时间稍长。CRPF组有2例因合并关节下粉碎性骨折导致复位不理想改行切开复位内固定治疗。CRPF组有个别患者的桡骨高度、掌倾角有丢失,但2组的PRWE评分、影像学及功能结果、并发症情况差异无统计学意义(P>0.05)。结论 2种方法对于单纯桡骨远端关节内简单骨折的远期效果均良好,但合并关节面下粉碎性骨折的患者,ORIF的疗效更佳。

Objective To compare efficacy of closed reduction and plaster external fixation （CRPF） and open reduction and internal fixation （ORIF） for treatment of simple intra-artieular distal radial fractures. Methods Comparison of CRPF and ORIF was made by 56 cases of simple intra-articular distal radius fractures between Oct. 2011 and Oct. 2013. The following indicators were compared： the motion of the wrist; imaging measurements; PRWE score; complications and reoperation cases. Results All fractures were healed, ORIF group averaged a slightly longer healing time. Two patients in CRPF group changed into ORIF because of combined proximal comminuted fractures. Individual patients＂ radial height and palmar angle were lost in CRPF group, but there were no significant differences in the PRWE scores, radiographic and functional outcomes, complications between two groups （P〉0.05）. Conclusion Both two methods for simple intra-articular distal radius fractures display well long-term results, but for those combined with proximal comminuted fractures, ORIF provides better effects.