老年桡骨远端C型骨折3种治疗方法的疗效对比

Comparison of Three Methods in the Treatment of Senile Distal Radial Fractures of Type C

目的:比较手法复位夹板外固定、闭合复位支架外固定以及切开复位锁定加压接骨板内固定治疗老年桡骨远端C型骨折的临床疗效。方法:回顾性分析2012年1月至2014年12月单侧新鲜闭合性老年桡骨远端C型骨折共90例,其中手法复位夹板外固定(A组)32例,闭合复位支架外固定(B组)28例,切开复位锁定加压接骨板内固定(C组)30例。男34例,女56例;年龄60~85岁,平均年龄72.3岁。3组患者年龄、性别、骨折分型、致伤原因、合并伤、受伤至就诊时间等一般资料比较,差异无统计学意义(P>0.05)。1年随访时比较腕关节活动度、尺偏角、掌倾角、桡骨高度及Gartland-Werley腕关节功能评分,同时记录骨折愈合时间及其保守或手术治疗并发症。结果:3组患者均获随访,随访时间12~24个月,平均18.4个月。1年随访时尺偏角、掌倾角、桡骨高度及骨折愈合时间等比较,A组较B组、C组差,差异有统计学意义(P<0.05),B组、C组间差异无统计学意义(P>0.05);腕关节活动度、Gartland-Werley腕关节功能评分比较,A组较B组差,B组又较C组差,差异均有统计学意义(P<0.05)。结论:在影像学评估方面,闭合复位支架外固定及切开复位锁定加压接骨板内固定优于手法复位夹板外固定;在功能评价方面,切开复位锁定加压接骨板内固定优于闭合复位支架外固定及手法整复夹板外固定。因此,在严格掌握手术适应症及禁忌症的前提下,切开复位锁定加压接骨板内固定能够更好地达到解剖复位、坚强固定、早期功能锻炼的目的,是治疗老年桡骨远端C型骨折较为理想的方法。

Objective： To compare the clinical efficacy of manual reduction and splint external fixation, closed reduction and xator external fixation, open reduction and locking compression plate internal fixation for senile distal radius fracture of type C. Methods： From January 2012 to December 2014, the medical records of 90 patients with unilateral fresh closed senile distal radius fracture of type C were analyzed retrospectively, wherein manual reduction and splint external fixation was used in 32 cases（group A）, closed reduction and xator external fixation was used in 28 cases（group B）, and open reduction and locking compression plate internal fixation was used in 30 cases（group C）. There were 34 males and 56 females, and ranged in age from 60 to 85 years with an average age of 72.3 years. There was no statistically significant difference among the three groups in terms of general information such as age, sex, fracture classification, causes, combined injury and injury to visit time（P〉0.05）. We compared the three methods in terms of such indications as wrist range of activities, ulnar deviation, palm inclination, radial height, Gartland-Werley wrist function scores 1 year after surgery, and recorded healing time and its conservative or operative complications. Results： Patients were followed up for 12 to 24 months with an average of 18.4 months. After 1 year follow-up, the indicators such as ulnar deviation, palm inclination, radial height and fracture healing time of group A were worse than those of the group Band C, the difference was statistically significant（P〈0.05）, and no statistically significant difference between the group B and group C（P〉0.05）. Wrist joint activity and Gartland-Werley wrist function score in the group A was worse than that in the group B, and group B was worse than that in the group C, the difference was statistically significant（P〈0.05）.Conclusions： Closed reduction and xator external fixation and open reduction and locking compression plate internal fixation are superior to manual reduction and splint external fixation in terms of radiographic assessment; open reduction and locking compression plate internal fixation is better than closed reduction and fixator external fixation and manual reduction and splint external fixation in terms of function evaluation. Therefore, on the premise of strictly mastered the operation indications and contraindications, open reduction and locking compression plate internal fixation can better able to reach the requirements of anatomical reduction, strong fixation and early function exercise. It is currently one of the ideal methods for treatment of distal radius fracture of type C.