保守治疗与解剖锁定钢板内固定治疗老年性桡骨远端C型骨折的疗效比较

Comparison of the Clinical Curative Effects of Anatomic Locking Plate Internal Fixation and Conservative Treatment in Elderly Patients with C Type Distal Radius Fractures

【目的】比较保守治疗与解剖锁定钢板内固定治疗老年桡骨远端C型骨折的临床疗效。【方法】选择2012年3月至2014年3月在本院接受治疗的桡骨远端C型骨折的老年患者50例，按其接受的治疗方式不同分为切开复位掌侧解剖锁定钢板内固定手术治疗组（A组）和闭合手法复位高分子石膏固定的保守治疗组（B组），通过影像学资料比较桡骨远端各项指标恢复情况;采用视觉模拟评分表（VAS）评估患侧腕关节的疼痛程度、采用改良GarlandWerlery评分系统及腕关节功能评分（PatientRated Wrist Evaluation，PRWE）评估腕关节的功能恢复情况并比较。【结果】两组在掌倾角、尺偏角、桡骨缩短长度及关节面塌陷程度等桡骨远端指标较术前均明显改善（P〈0.05）。末次随访时，A组各项指标优于B组（P〈0.05）； A组VAS评分低于B组,其差异有统计学意义（P〈0.05）；GartlandWerlery优良率评分显示：A组优良率为88.5%，显著高于B组75.0%，其差异有统计学意义（P〈0.05）；A组的PRWE评分低于B组，其差异有统计学意义（P〈0.05）。【结论】两种方案均可有效治疗老年桡骨远端C型骨折，但切开复位解剖锁定钢板内固定能更好的恢复和维持桡骨远端掌倾角、尺偏角、桡骨茎突高度及关节面平整度，减少桡骨缩短长度，从而使腕关节功能恢复更优，还能更有效减轻关节疼痛，减轻患侧腕关节创伤性关节炎症状，是一种更有效的治疗方法，但临床选择治疗方案时仍需综合考虑患者的自身状况及患者个人意愿。

【Objective】To compare the clinical curative effects of anatomic locking plate internal fixation and conservative treatment in elderly patients with C type distal radius fractures.【Methods】Fifty elderly patients with C type distal radius fractures who were treated in our treatment group between March 2012 and March 2014 were selected. According to different treatment methods, the patients were divided into open reduction with volar locking plate internal fixation group （group A） and close manipulative reduction with macromolecule plaster immobilization conservative treatment group （group B）. Through imaging data, the recovery of indexes of distal radius fractures was compared; The wrist pain degree was evaluated by visual analogue scale （VAS）; The recovery of wrist function was evaluated by modified GartlangdWerlery scoring system and PatientRated Wrist Evaluation （PRWE）. 【Results】After surgery, the recovery of distal radius indexes such as palmar tilt, ulnar inclination, radial shortening length and degree of articular surface collapse were significantly improved （P〈0.05）. At the end of followup, the values of group A were better than those of group B （P〈0.05）; VAS score of group A was lower than that of group B （P〈0.05）, the difference was statistically significant （P〈0.05）; The excellent and good rate of GartlangdWerlery score in group A was 88.5%, which was much better than that of group B 75.0% （P〈0.05）; The PRWE score of group A was lower than that of group B, the difference was statistically significant （P〈0.05）. 【Conclusion】 Both of the two regimens can effectively treat elderly patients with C type distal radius fractures. However, open reduction with anatomic locking plate internal fixation can better restore and maintain distal radius palmar tilt, ulnar inclination, height of processus styloideus radii and flatness of articular surface, reduce radial shortening length, so that the wrist joint function can recover better. It also can effectively reduce joint pain and symptoms of traumatic arthritis in the affected wrist. It is a more effective treatment for the disease. However, when choosing clinical treatment methods, the patient＇s condition and patient＇s must be taken into consideration.