老年桡骨远端C3型骨折两种内固定方式的疗效比较

Comparison of clinical effects of two internal fixations on C3 distal radius fractures in the elderly

目的探讨两种内固定方式治疗老年桡骨远端C3型骨折的临床疗效。方法收集2014年10月年—2016年4月间手术治疗的老年桡骨远端C3型骨折38例,其中掌侧锁定钢板内固定20例,掌侧普通钢板加单边外固定架18例(术后2个月取除外固定架)。术后3个月、12个月观察两组患者骨折复位、愈合、钢板内固定位置等影像学及患腕关节临床功能等情况并进行统计比较,腕关节的关节功能评估采用Mayo评分。结果 38例均获12~28个月(平均16个月)随访。术后3个月发现两组患者骨折均基本愈合,其中锁定钢板组1例患者桡骨缩短、掌倾角丢失,余患者均无复位丢失、无内固定松动断裂;临床患腕功能钢板组患者Mayo评分平均为86.3±12.2,其中优10例,良9例,可1例,优良率95%;普通钢板加外固定组Mayo评分平均为81.9±14.3,其中优6例,良9例,可3例,优良率83%,两组差异有统计学意义(P<0.05)。术后12个月随访影像学发现两组患者骨折愈合良好,骨折复位较术后3个月无丢失,无内固定位置不良等表现,锁定钢板组Mayo评分平均为93.2±10.3:其中优14例,良5例,可1例,优良率95%;普通钢板加外固定组腕关节Mayo平均评分为90.6±12.1,其中优11例,良6例,可1例,优良率94%,两组比较差异无统计学意义(P<0.05)。结论掌侧锁定钢板及普通钢板加单边外固定架两种内固定方式均能有效治疗老年桡骨远端C3型骨折,但掌侧锁定钢板内固定对患腕关节早期功能恢复具有一定优势。

Objective To explore the clinical effects of two internal fixations on C3 distal radius fractures in the elderly. Methods Thirty-eight elderly patients with C3 distal radius fractures received surgical treatment between October 2014 and April 2016. Among them,20 cases had internal fixation with locking volar plates, and 18 cases used traditional nonlocking volar plates and monolateral external fixators （ the external fixators were removed two months later）. The radiographs of fracture reduction,healing,and internal fixation sites,as well as clincal functions such as wrist function,at 3 and 12 months postoperative were followed and compared between the two groups. Mayo scores were used to evaluate wrist function. Results The 38 cases were followed up for an average of 16 months （between 12 and 20 months） after surgery. At 3 months postoperative,both groups healed without reduction lost or internal fixation loose, except that one case who used locking volar plates showed distal radius shortening and radial inclination loose. The mean Mayo score of the group using locking volar plates was 86. 3 ± 12. 2： excellent for 10 cases,good for 9 cases,and satisfactory for 1 case, with an excellent-and-good rate of 95% ; the mean Mayo score of the group using traditional nonlocking volar plates and monolateral external fixators was 81.9 ± 14. 3： excellent for 6 cases, good for 9 cases, and satisfactory for 3 cases,with an excellent-and-good rate of 83% ;there was a statistical difference between the two groups（P 〈0.05）. At 12 months postoperative,both groups healed well without reduction lost or internal fixation loose. The mean Mayo score of the group using locking volar plates was 93. 2 ± 10. 3：excellent for 14 cases,good for 5 cases,and satisfactory for 1 case, with an excellent-and-good rate of 95% ; the mean Mayo score of the group using traditional nonlocking volar plates and monolateral external fixators was 90. 6 ± 12. 1：excellent for 11 cases,good for 6 cases,and satisfactory for 1 case, with an excellent-and-good rate of 94% ;there was no difference between the two groups （P 〉 0. 05）. Conclusion Both the studied internal fixations, locking volar plates and traditional nonlocking volar plates plus monolateral external fixator, are effective for C3 distal radius fractures of the elderly, but the former one has a better effect on the early recovery of wrist function.