外固定支架联合抗骨质疏松治疗骨质疏松性桡骨远端粉碎性骨折的疗效

External Fixation Combined with Anti-Osteoporosis Treatment for Osteoporotic Comminuted Distal Radius Fractures

目的探讨外固定支架联合抗骨质疏松治疗骨质疏松性桡骨远端粉碎性骨折的临床疗效.方法对20 例骨质疏松性桡骨远端粉碎性骨折患者（A3型2例,C2型9 例,C3型9例）均采用外固定支架（单纯手法牵引复位加外固定架16 例,经皮钢针撬拨复位加外固定架4 例）联合抗骨质疏松（补充钙剂、降钙素等）治疗.术前,术后6、12个月采用双能X 线骨密度测量仪测定骨密度.结果20例患者均获3～30个月,平均12个月的随访.术前患者尺偏角为-16°～14°（平均10.5°）,掌倾角为-30°～0°（平均-10°）;术后患者尺偏角为20°～35°（平均25°）,掌倾角为0°～20°（平均11.5°）,术后掌倾角及尺偏角明显优于术前（P〈0.05）.术后骨折愈合时间为6.1个月,支架拆除时间为6～22周.按Dienst功能评估标准：优9例,良8例,可3例,优良率为85.0%.治疗6个月时骨密度上升6.12%,12个月后上升至9.04%,与治疗前比较差异有统计学意义（P〈0.05）.无针道感染、针孔骨折,医源性神经、血管损伤、伤口感染及骨髓炎等并发症发生.结论外固定支架联合抗骨质疏松治疗,手术操作简单、固定可靠、骨密度明显增加,并发症少,是治疗骨质疏松性桡骨远端粉碎性骨折的-种较好的方法,

ABSTRACT:Objective To investigate the clinical effect of external fixation combined with anti-osteoporosis treatment on osteoporotic comminuted distal radius fractures.Methods Twenty pa-tients with osteoporotic comminuted distal radius fractures(2 patients with type A3 fractures,9 patients with type C2 fractures,and 9 patients with type C3 fractures)received external fixation (16 patients received simple traction and external fixation,and 4 patients received percutaneous needle reduction and external fixation)and anti-osteoporosis treatment(calcium supplementation, calcitonin,etc.).Bone mineral density was measured by using dual-energy X-ray absorptiometry before treatment and 6 and 12 months after treatment.Results All patients were followed up for 3-30 months(average,12 months).The average ulnar deviation was 10.5°(range,- 16°-14°)be-fore operation,and 25°(range,20°-35°)after operation.The average palmar tilt was -10°(range,-30°-0°)before operation,and 11.5°(range,0°-20°)after operation.Both ulnar deviation and pal-mar tilt were obviously improved after operation(P <0.05).Postoperative fracture healing time was 6.1 months,and fixator removal time was 6-22 weeks.According to Dienst standard,thera-peutic effect was excellent in 9 patients,good in 8 patients,and fair in 3 patients.The excellent and good rate was 85.0%.Bone mineral density was significantly increased by 6.12% after treat-ment for 6 months,and 9.04% after treatment for 12 months(P <0.05).No pin tract infection, pinhole fracture,iatrogenic nerve and blood vessel injury,wound infection,osteomyelitis,and oth-er complications occurred in all patients.Conclusion External fixation combined with anti-osteo-porosis treatment can increase bone mineral density and decrease complications in the treatment of osteoporotic comminuted distal radius fractures with advantages of simple operation and reliable fixation.