单纯掌侧或背侧钢板治疗桡骨远端关节内骨折的疗效分析

Curative effect of simple volar or dorsal plating in the treatment of intra.articular distal radius fracture

目的比较单纯掌侧或背侧钢板治疗桡骨远端关节内骨折的疗效，推荐最佳的手术方式。方法回顾性分析42例桡骨远端关节内骨折手术治疗的患者，均为闭合性骨折。15例采用背侧钢板（背侧组），男5例，女10例；年龄48～62[（55±7）岁]。致伤原因：摔伤13例，交通伤2例。AO分类为C3型10例，C2型5例。27例采用掌侧钢板（掌侧组），男8例，女19例；年龄50—62岁[（56±6）岁]。致伤原因：摔伤24例，交通伤3例。AO分类为C3型17例，C2型10例。比较两组术后腕部的活动范围、影像学参数、并发症、臂肩手功能（DASH）评分以及Gartland—Werley评分。结果42例患者均获得11～25个月的随访，两组腕部活动范围以及影像学参数的差异均无统计学意义（P〉0．05）。Gartland—Werley评分掌侧组明显低于背侧组[1分：4分，P〈0．05]，而两组DASH评分差异无统计学意义（P〉0．05）。背侧组4例（27％）发生肌腱粘连，需行肌腱松解术；掌侧组1例（4％）发生正中神经症状（P〈0．05）。结论尽管两种治疗方法DASH评分相近，掌侧钢板Gartland—Werley评分及并发症发生率要优于背侧钢板。因此，掌侧钢板是治疗桡骨远端关节内骨折较好的方法。

Objective To compare the clinical effect of simple volar or dorsal plate fixation of intra-articular distal radius fracture. Methods This retrospective study included 42 patients with closed intra-articular distal radius fracture treated surgically using the dorsal or volar plate. Out of the 15 patients in dorsal plating group 5 were males and 10 females at age of （55 ± 7 ）years （range, 48- 62 years） , 13 were injured from falls and 2 traffic accidents, 10 were classified as AO type C3 and 5 AO type C2. Out of the 27 patients in volar plating group 8 were males and 19 females at age of （56 ± 6）years （range, 50-62 years） , 24 were injured from falls and 3 traffic accidents, 17 were classified as AO type C3 and 10 AO type C2. Between-group differences were compared with respect to wrist range of motion, postoperative radiographic parameters, postoperative complications, disabilities of the arm, shoulder and hand （DASH） score and Gartland-Werley score. Results All the patients were followed up for 11-25 months. There were no significant differences in the wrist range of motion and radiographic parameters between the two groups （ P 〉 0.05 ）. Volar plating group resulted in a significantly better Gartland-Werley score compared to dorsal plating group [ 1 vs 4 points, P 〈 0.05 ] , but no significant difference was noted in DASH score （P 〉 0. 05）. Four patients （27%） in dorsal plating group developed tendon adhesions and tenolysis was in demand, but one patients （4%） in volar plating group was complicated by median nerve symptoms （P 〈 0.05 ）. Conclusions Although the DASH score of the two methods was similar, volar plating yields better results in Gartland-Werley score and complication incidence. Thus the volar plating is recommended for intra-articular distal radius fracture.