开放复位锁定加压钢板与外固定架加克氏针固定治疗桡骨远端关节内骨折的临床效果观察

Clinical effects observation of open limited contact compression plate and external fixation combined with kirschner wire for intra-articular fracture of distal radius

目的：探讨采用开放复位锁定加压钢板（ AOLCP）与骨外固定架结合克氏针手术固定治疗桡骨远端关节内骨折的临床效果差异。方法回顾性分析我院2012年1月～2013年7月收治的135例桡骨远端关节内骨折患者的治疗资料，根据手术方式分为AOLCP组（72例）和克氏针组（63例），比较两组患者术后骨折愈合情况、腕关节的活动度及桡骨远端骨折功能评估差异。结果 AOLCP组患者骨折平均愈合时间为（6．2±1．3）周，与克氏针组（6．6±1．2）周比较差异不显著（t＝1．848，P＝0．062）。两组患者术后骨折均愈合，均未出现延迟愈合和畸形愈合。术后第6、12个月对两组患者的腕关节活动度进行测定。 AOLCP组患者的掌屈、背伸、旋前、旋后、桡偏较克氏针组差异显著，且AOLCP组患者的腕关节活动度优于克氏针组（P＜0．05）。 AOLCP组患者第12个月的Dienst腕关节功能分布显著优于克氏针组（P＜0．05）； AOLCP组的优良率为84．72％，显著高于克氏针组69．84％（P＜0．05）。结论采用开放复位锁定加压钢板治疗桡骨远端关节内骨折能够取得较好的远期疗效，对患者腕关节功能恢复有利。

Objective To investigate the differences in the clinical effects between an open limited contact compression plate （ AOLCP） and external fixation combined with kirschner wire for distal radius intra-articular frac-ture.Methods The clinical data of 135 cases of distal radius intra-articular fracture in our hospital from Jan.2012 to Jun.2013 was analyzed.The cases were divided into AOLCP group（72 cases） and kirschner wire group（63 ca-ses） .The fracture healing, the range of motion in wrist joints and the difference in functional evaluation of distal radius fracture after treatment between two groups were compared.Results There was no significant difference in the average healing time between AOLCP group（6.2 ±1.3 weeks） and kirschner wire group（6.6 ±1.2 weeks;t=1.848,P=0.062）.They were all healed and excluded with delayed healing and malunion.In the 6th and 12th months after treatment,the range of motion in wrist joints in two groups was measured.The results showed that the palmar flexion range of motion,dorsiflexion,pronation,supination,radial deviation,ulnar deviation in AOLCP group were significantly different from those in kirschner wire group and the mobility range of wrist joints of AOLCP group was superior to kirschner wire group（P〈0.05）.In the 12th month after treatment,the Dienst score of wrist joints function in AOLCP group was significantly higher than that in the kirschner wire group（P〈0.05）.The excellent rate in AOLCP group was 84.72%, significantly higher than that in kirschner wire group （ 69.84%, P〈0.05 ） . Conclusion The treatment for distal radius fracture by AOLCP can get better long-term effects and is beneficial to the function recovery of wrist joints.