不同手术治疗C型桡骨远端骨折的效果比较

Different surgical procedures in treatment of type C distal radius fractures

目的 探究不同手术治疗C型桡骨远端骨折的效果差异.方法 将本院骨科2012年4月至2013年5月收治的96例新鲜C型桡骨骨折患者纳入研究对象.按照手术方法的不同分为外固定架组（45例）和掌侧锁定加压钢板内固定组（51例）.对两组临床资料行回顾性分析,并经术后随访比较两组术中情况、影像学指标、术后疗效以及不良反应情况.结果 内固定组的术中出血量、手术时间和住院时间分别为（42.55±8.84） ml、（55.16±13.67） min、（8.92±4.13）d,显著高于外固定架组的（38.29±5.76）ml、（47.98±12.42） min、（7.68±3.11）d（P＜0.05）;术后3个月时内固定组掌倾角度、尺偏角度和桡骨高度分别为（9.53±4.46）°、（20.56±4.26）°、（12.48±3.50）cm,均明显高于外固定架组（7.72±3.81）°、（18.75±3.73）°、（11.32±2.39）cm （P＜0.05）;术后1年内固定组的腕关节功能Gartland-Werley评估优良率为91.11％,与外固定架组的82.35％相当（P＞0.05）;内固定组术后1年内感染、神经损伤等不良情况发生率为6.67％,与外固定架组的7.84％差异不大（P＞0.05）.结论 掌侧锁定加压钢板内固定与外固定架治疗C型桡骨远端骨折均有较好的疗效,但外固定架手术创伤小,锁定加压钢板内固定更利于术后早期关节活动,临床可根据患者实际情况选择两种手术方式.

Objective To explore the differences of the effects of different surgical procedures in the treatment of type C distal radius fractures.Methods 96 patients with new type C distal radius fractures admitted into our hospital from April,2012 to May,2013 were included in the study.According to different surgical methods,they were divided into an external fixator group （45 cases） and a volar locking compression plate internal fixation group （51 cases）.The clinical data of the two groups were retrospectively analyzed.Through postoperative follow-up,the intraoperative status,imaging indexes,postoperative curative effect,and adverse reactions were compared between these groups.Results The intraoperative bleeding volume,operation time,and hospitalization time were （42.55 ±8.84） ml,（55.16±13.67） min,and （8.92±4.13） d in the internal fixation group and were （38.29±5.76） ml,（47.98±12.42） min,and （7.68±3.1 1） d in the external fixation group （P 〈 0.05）.3 months after the operation,the volar tilt angle,ulnar deviation angle,and radial height were （9.53±4.46） °,（20.56±4.26） °,and （12.48±3.50） cm in the internal fixation group and were （7.72±3.81） °,（18.75±3.73）°,and （11.32±2.39） cm in the external fixation group （P 〉 0.05）.One year after surgery,the excellent and good rate of Gartland-Werley evaluation for wrist joint function was 91.11% in the internal fixation group and was 82.35% in the external fixation group （P〉0.05.The incidence of infection,nerve injury,and other adverse events within one year after surgery was 6.67% in the internal fixation group and was 7.84% in the external fixation group （P〉0.05）.Conclusions Both volar locking compression plate internal fixation and external fixator in the treatment of type C distal radius fractures have relatively good curative effects,but the trauma caused by external fixator surgery is smaller and locking compression plate internal fixation is more conducive to early postoperative joint motion.Therefore,in clinic,both surgical methods can be chosen according to the patients＆#39; actual situation.