掌侧锁定钛板与外固定架治疗C型桡骨远端骨折的中期疗效比较

A comparative study of medium-term outcomes of type C distal radial fractures treated with volar locking compression plate and external fixation

目的 比较切开复位掌侧斜“T”型锁定加压钛板（locking compression plate,LCP）内固定和闭合复位外固定架（external fixation,EF）固定治疗C型桡骨远端骨折的中期疗效.方法 回顾性分析2010年5月至2012年11月治疗的60例C型桡骨远端骨折患者资料.采用掌侧斜“T”型LCP治疗（LCP组）36例,男21例,女15例;年龄17～ 80岁,平均（45.94±16.29）岁;左20例,右16例;AO分型C1型7例,C2型20例,C3型9例.采用外固定架治疗（EF组）24例,男16例,女8例;年龄16～79岁,平均（44.63±14.55）岁;左15例,右9例;AO分型C1型4例,C2型13例,C3型7例.比较两种方法治疗后腕关节活动度、视觉模拟评分（visual analogue scale,VAS）、Gartland-Werley腕关节评分及掌倾角、尺偏角、桡骨高度.结果 患者均获随访,LCP组随访平均（42.03±8.62）个月,EF组随访平均（37.24±9.77）个月.LCP组VAS评分（1.28±0.78）分,Gartland-Werley评分（2.28±0.78）分,腕关节掌屈50.89°±5.53°、背伸50.69°±5.38°;EF组VAS评分（1.38±0.71）分,Gart-land-Werley评分（2.92±1.69）分,腕关节掌屈50.96°±5.01°、背伸51.08°±5.73°;两组以上指标比较差异均无统计学意义.术后2年,LCP组掌倾角10.69°±2.29°、尺偏角22.53°±1.95°、桡骨高度（10.63±1.14） mm;EF组掌倾角6.63°±2.76°、尺偏角16.96°±4.41°、桡骨高度（9.06±0.98） mm;两组各指标比较差异均有统计学意义.结论 LCP和EF治疗C型桡骨远端骨折术后中期均可获良好疗效,但LCP可在直视下复位骨折,其在尺偏角、掌倾角、桡骨高度恢复等方面明显优于EF术.

Objective To compare the medium-term clinical effects of oblique T-shaped volar locking compression plate （LCP） and external fixation （EF） treating type C distal radial fractures.Methods Data of 60 patients with type C distal radial fractures who underwent surgery in our hospital from May 2010 to November 2012 were retrospectively analyzed.36 patients received open reduction with LCP fixation （LCP group）,among which there were 21 males and 15 females,and there were 20 left wrists and 16 right wrists with an average age of 45.94±16.29 years old （range,17-80 years old）.24 patients received close reduction and external fixation （EF group）,among which there were 16 males and 8 females,and there were 15 left wrists and 9 right wrists with an average age of 43.63±14.55 years old （range,16-79 years old）.The clinical results of wrist joint were assessed by range of wrist activity,VAS,Gartland-Werley wrist score,postoperative radial tilt angle,radial inclination angle and radial height.Results All the 60 patients were followed up successfully.The LCP group was followed up for 24 to 55 （42.03 ± 8.62） months.The EF group was followed up for 24 to 54 （37.24±9.77） months.In the LCP group,the average VAS score was 1.28±0.78,Gartland-Werley score 2.28±0.78,wrist flexion angle 50.89°±5.53° and wrist dorsiflexion angle 50.69°±5.38°.In the EF group,the average VAS score was 1.38±0.71,Gartland-Werley score 2.92± 1.69,wrist flexion angle 50.96°±5.01° and wrist dorsiflexion angle 51.08°± 5.73°.No statistically differences were found in wrist joint function between two groups.In LCP group,radiological evaluation 2 years after operation showed that the average radial tilt angle was 10.69°±2.29,radial inclination angle 22.53°± 1.95° and radial height 10.63±1.14 mm.In the EF group,radial tilt angle was 6.63°±2.76°,radial inclination angle 16.96°±4.41° and radial height 9.06±0.98 mm.Significant differences were found in radial tilt angle,radial inclination angle and radial height.No statistically differences were found in postoperative complication rates.Conclusion Locking compression plate （LCP） fixation and external fixation （EF） can obtain similar satisfactory medium-term clinical outcome in treating type C distal radial fractures.Comparison with EF,LCP can achieve anatomic reduction under direct vision,and its radiological assessments including radial tilt angle,radial inclination angle and radial height were significantly better than external fixation.