切开复位钢板内固定及闭合复位外固定架固定治疗不稳定型桡骨远端骨折患者的比较研究

Unstable Distal Radius Fractures:Comparative Study of Open Reduction and Plate Internal Fixation and External Fixation Treatment

目的:比较切开复位钢板内固定及闭合复位外固定架固定治疗不稳定型桡骨远端骨折的临床疗效,为临床治疗方式的选择提供参考。方法:选择2014年1月至2016年1月间于我院骨科就诊的桡骨远端骨折患者102例作为研究对象。按患者的治疗方式分为内固定组(n=52)和外固定组(n=50)。内固定组患者采用切开复位钢板内固定进行治疗,外固定组患者采用闭合复位外固定架固定进行治疗。术后3个月及术后1年通过影像学测量两组患者的关节面台阶、掌倾角和尺偏角,同时测量患者腕部功能情况。随访1年,比较两组患者疗效,并观察患者并发症发生情况。结果:术后3个月及术后1年,内固定组患者关节面台阶、掌倾角和尺偏角均低于外固定组患者,差异均具有统计学意义(P<0.05)。术后3个月,内固定组的旋前旋后活动度、屈伸活动度、桡尺偏活动度、捏力、握力均明显高于外固定组(P<0.05),但两组的上述指标在术后1年比较无统计学差异(P>0.05)。内固定组患者治疗有效率为86.54%,外固定组患者治疗有效率为86.00%,差异无统计学意义(P>0.05)。内固定组并发症发生率为15.38%,外固定组并发症发生率为18.00%,差异无统计学意义(P>0.05)。结论:与闭合复位外固定架固定相比,切开复位钢板内固定治疗对患者关节面台阶、掌倾角和尺偏角的恢复效果较好,同时患者能及早进行腕部功能锻炼,近期疗效更加明显。

Objective： To compare the clinical effect of open reduction and plate intemal fixation and external fixation treatment on unstable distal radius fractures, so as to provide reference for the choice of clinical treatment. Methods： A total of 102 patients with unstable distal radius fractures, who were treated in department of orthopedics in Cangzhou Central Hospital of Hebei Province from January 2014 to January 2016, were selected and divided into internal fixation group （n=52） and external fixation group （n=50） according to different treatment methods. The patients in the internal fixation group were treated with open reduction and plate internal fixation, while the patients in the external fixation group were treated with external fixation. The joint surface steps, palm angle and ulnar angle of the two groups 3 months and 1 year after surgery were measured by iconography, and the wrist function was measured simultaneously. After a year of follow-up, the efficacy of the two groups were compared, and the complications were observed. Results： Three months and 1 year after surgery, the joint surface steps, palm angle and ulnar angle of patients in the internal fixation group were better than those in the external fixation group, and the differences were statistically significant（P〈0.05）. 3 months after surgery, the pronation and supination ac- tivity, flexion and extension activity, radial ulnar deviation activity, pinch strength and grip strength of patients in the internal fixation group were significantly better than those in the external fixation group （P〈0.05）, but there was no significant difference in those indexes be- tween the two groups 1 year after surgery （P〉0.05）. The effective rate was 86.54% in the internal fixation group and 86.00% in the exter- nal fixation group, the difference was not statistically significant （P〉0.05）. The complication rate was 15.38% in the internal fixation group and 18.00% in the external fixation group,the difference was not statistically significant （P〉0.05）. Conclusion： Compared with the external fixation, the open reduction and plate internal fixation has a better effect on the recovery of joint surface step, palm angle and ulnar deviation angle, and the patients also can perform wrist exercises as early as possible, and the short-term curative effect is more obvious.