不同固定方式对C型桡骨远端骨折术后长度维持以及腕关节功能恢复的影响

Effect of different fixation methods on the length of type C of distal radius fractures and the recovery of wrist joint function

目的 探讨外固定架骨折固定术与掌侧锁定加压钢板骨折内固定术对C型桡骨远端骨折术后长度维持以及腕关节功能恢复的影响.方法 选取2014年5月至2015年7月74例C型桡骨远端骨折患者,根据固定方式不同分为对照组（n=37）和研究组（n=37）.对照组采用外固定架骨折固定术,研究组采用掌侧锁定加压钢板骨折内固定术,术后1年进行随访.统计两组腕关节功能优良率、并发症发生率,并对比手术前后两组腕关节活动度变化情况及桡骨远端长度丧失值.结果 研究组腕关节功能优良率（91.89%）高于对照组（72.98%）,差异有统计学意义（P〈0.05）;术前两组腕关节屈伸活动度、桡尺偏活动度、旋前旋后活动度比较差异未见统计学意义（P〉0.05）,术后研究组各指标水平优于对照组,差异有统计学意义（P〈0.05）;研究组桡骨远端长度丧失值[（0.81±0.55）mm]少于对照组[（3.17±1.06）mm],差异有统计学意义（P〈0.05）;研究组并发症发生率（10.81%）与对照组（13.51%）比较差异未见统计学意义（P〉0.05）.结论 采用掌侧锁定加压钢板骨折内固定术治疗C型桡骨远端骨折效果显著,可有效维持患者术后桡骨远端长度,改善腕关节活动度及功能,具有较高安全性,值得推广运用.

Objective To investigate the effect of external fixation with locking compression plate internal fixation on the length of type C of distal radius fractures and the recovery of wrist joint function.Methods Seventy-four patients with type C distal radius fractures in hospital were divided into control group （n=37） and study group （n=37） according to the different fixation methods from May 2014 to July 2015.The control group was treated by external fixation,the study group was treated by palm side locking compression plate internal fixation,1 year after surgery were followed up.The wrist function excellent rate,incidence of complications were analyzed,and the wrist activity changes and the loss of the distal radius before and after operation were compared.Results The good rate of wrist joint function in the study group （91.89%） was higher than that in the control group （72.98%）,and the difference was significant （P〈0.05）.The preoperative wrist flexion and extension,ulnar radial motion,pronation supination comparison showed no significant difference between the two groups （P〉0.05）;the postoperative indicators of the study group was better than those of the control group,the differences were significant （P〈0.05）.In the study group,the loss of distal radius [（0.81±0.55） mm] was less than that in the control group [（3.17±1.06） mm],and the difference was significant （P〈0.05）.The complication rate between the study group （10.81%） and the control group （13.51%） had no siginficant difference（P〉0.05）.Conclusions The effect of volar locking compression plate internal fixation on type C fracture of the distal radius is significant,it can effectively maintain the postoperative patients with distal radius length,improve the wrist movement and function,and has high safety,so it is worthy of promotion.