掌侧锁定钢板与保守疗法治疗老年桡骨远端粉碎性骨折的疗效比较

Volar plating versus nonoperative treatment for senile comminuted fractures of distal radius

目的比较手法复位石膏外固定与切开复位掌侧锁定钢板内固定治疗老年桡骨远端粉碎性骨折的疗效。方法回顾性分析2012年10月至2015年6月期间收治的46例老年桡骨远端粉碎性骨折患者资料。根据治疗方式不同分为2组：钢板内固定组20例，男7例，女13例；平均年龄为（67．9±10．7）岁；骨折AO分型：23-B型7例，23-C型13例；采用切开复位掌侧锁定钢板内固定治疗。保守治疗组26例，男8例，女18例；平均年龄为（66．2±11．5）岁；骨折AO分型：23-B型10例，23-C型16例；采用闭合复位石膏外固定治疗。比较两组患者的随访时间、骨折愈合时间、骨折复位质量、腕关节功能评分及并发症发生情况等。结果两组患者随访时间比较差异无统计学意义（P〉0．05）。两组患者骨折均在治疗后11周左右获得愈合。术后骨折复位质量按Dienst等推荐的评分标准评定：钢板内固定组优13例，良4例，中2例，差1例，优良率为85．0％；保守治疗组优5例，良10例，中5例，差6例，优良率为57．7％，差异有统计学意义（P〈0．05）。钢板内固定组患者末次随访时Gartland＆Werley腕关节功能评分[（2．16±1．82）分]和术后并发症发生率（30．0％，6／20）均显著低于保守治疗组患者[（6．62±3．78）分、53．8％（14／26）]，差异均有统计学意义（P〈0．05）。结论对于老年桡骨远端粉碎性骨折，掌侧锁定钢板固定较保守治疗可获得更好的腕关节功能，术后并发症发生率更低。但在选择治疗手段时应慎重，充分尊重患者身体条件和自身需求。

Objective To compare volar plating and nonoperative treatment for senile comminuted fractures of the distal radius. Methods From October 2012 to June 2015, 46 senile comminuted fractures of the distal radius （AO types B and C） were treated surgically or conservatively. Twenty old patients were managed by open reduction and fixation with a volar locked plate. They were 7 men and 13 women, with an average age of 67. 9 ± 10. 7 years, including 7 cases of AO type 23-B and 13 cases of AO type 23-C. Twenty-six patients were managed with closed reduction and plaster cast. They were 8 men and 18 women, with an average age of 66. 2 ± 11.5 years, including 10 cases of AO type 23-B and 16 cases of AO type 23-C. The 2 groups were compared in terms of follow-up time, union time and wrist functional scores and complica- tions. Results There was no significant difference between the 2 groups in follow-up time （ P 〉 0. 05） . Fractures in the 2 groups all united about 11 weeks after surgery. According to Dienst scoring for reduction, the volar plating group had 13 excellent cases, 4 good ones, 2 fair ones and one poor case, with an excellent to good rate of 85.0% while the nonoperative group had 5 excellent cases, 10 good ones, 5 fair ones and 6 poor ones, with an excellent to good rate of 57.7%. A significant difference was shown between the 2 groups （ P 〈 0. 05）. At final follow-ups, the volar plating group had significantly lower Gartland ＆ Werley wrist functional score （2. 16 ±1.82） and complication rate （30.0%, 6/20） than the nonoperative group[6.62 ±3.78 and 53.8% （14/26）, respectively] （ P 〈 0. 05） . Conclusion In treatment of senile comminuted fractures of the distal radius, volar locked plating may lead to better functional recovery and fewer complications than nonoperative management. However, one should take full account of the physical condition and preference of the patient when surgery is chosen.