掌侧锁定钢板结合不同植骨方式治疗桡骨远端陈旧性骨折

Correction osteotomy of the distal radius malunion stabilised with volar anatomical locking plate and bone grafting

目的探讨掌侧解剖型锁定钢板结合不同植骨方式治疗桡骨远端陈旧性骨折的临床疗效。方法回顾性分析2013年1月至2016年10月,我院采用截骨复位掌侧解剖型锁定钢板内固定联合不同植骨方式治疗桡骨远端陈旧性骨折患者34例,其中15例术中进行异体脱钙骨基质植骨(异体组),19例术中进行自体骨植骨(自体组)。统计术前术后的掌倾角、尺偏角以及桡骨高度情况、骨折愈合时间,术后桡骨高度丢失率,术后6个月时腕关节Cooney功能评分优良率。结果所有患者术后伤口一期愈合。34例均获(10.23±5.29)个月随访,平均骨折愈合时间(3.52±0.45)个月。异体组骨折愈合时间(3.75±0.15)个月,自体组骨折愈合时间(3.47±0.36)个月,两组间差异无统计学意义。异体组与自体组的术后6个月掌倾角[(7.3±6.4)°,(7.1±3.8)°]、尺偏角[(22.1±5.7)°,(21.9±4.2)°]和桡骨高度[(12.0±3.3)mm,(12.7±1.6)mm]均较术前明显改善,差异有统计学意义(P<0.01),但两组之间各个阶段的指标差异均无统计学意义(P>0.05)。两组术后6个月桡骨高度丢失率和腕关节Cooney功能评分优良率差异无统计学意义(P>0.05)。结论掌侧解剖型锁定钢板联合自体或异体骨植骨治疗桡骨远端陈旧性骨折可增强骨折复位及固定效果,促进骨折愈合,减少术后复位丢失,改善腕关节功能。同种异体脱钙骨基质可以代替自体骨进行植骨,避免了取骨手术带来的风险。

Objective To investigate the clinical effects of the volar anatomical locking plate and bone grafting in the treatment of the malunion of the distal radius. Methods From January 2013 to October 2016, 34 patients of malunion of the distal radius were treated by internal fixation with a volar anatomical locking plate and bone grafting. Among them, 15 patients were treated by allogeneic bone grafting（ Allogeneic Group）, while 19 patients with autologous bone grafting（ Autologous Group）. Preoperative and postoperative palm angle, ulnar deviation angle and radius height, fracture healing time, postoperative radial height loss rate, and postoperative Cooney function score of the wrist joint between the 2 groups were statistically analyzed. Results All the patients had primary healing after the operation. All the 34 patients were followed up（ 10.23 ± 5.29） months. The average fracture healing time was（ 3.52 ± 0.45） months. The fracture healing time：（ 3.75 ± 0.15） months in the Allograft Group;（ 3.47 ± 0.36） months in the Autogenous Group; no significant differences existed（ P 0.05）. The palm angle [（ 7.3 ± 6.4） °,（ 7.1 ± 3.8） ° ], ulnar inclination [（ 22.1 ± 5.7） °,（ 21.9 ± 4.2） ° ] and radial height [（ 12.0 ± 3.3） mm,（ 12.7 ± 1.6） mm ] postoperation were significantly improved compared with the data preoperation, with statistical significance（ P 0.01）. However, there were no significant differences between the 2 groups at different stages（ P 0.05）. There were no significant differences in the rate of radial height loss and the wrist Cooney function score between the 2 groups 3 months postoperatively（ P 0.05）. Conclusions The treatment of malunion of the distal radius with bone grafting can enhance the reduction and fixation of the fracture, promote the healing of the fracture, reduce the postoperative reduction of the height of the radius and improve the function of the wrist. Demineralized bone matrix can replace autologous bone for bone grafting, avoiding the risk of bone surgery.