三柱理论指导外固定架与锁定钢板内固定治疗AO-C型桡骨远端骨折的比较

Comparative study of AO type C distal radial fractures treated with locking plate and external fixator based on three column theory

目的探讨三柱理论指导下采用外固定架与锁定钢板内固定治疗AO-C型桡骨远端骨折的手术方法及临床疗效。方法回顾性分析自2014-10—2017-01在三柱理论指导下手术治疗的40例AO-C型桡骨远端骨折,其中18例采用解剖锁定钢板内固定治疗(锁定钢板组),22例采用可调节外固定架联合克氏针有限内固定治疗(外固定架组)。比较2组手术时间、术中出血量,以及末次随访时桡骨高度、掌倾角、尺偏角、腕关节活动度、腕关节功能Garland-Werley评分。结果 40例均获得随访,随访时间平均13(6~18)个月。X线片显示骨折均在3个月内愈合,均未出现骨折不愈合及骨萎缩。与锁定钢板组比较,外固定架组手术时间更短,术中出血量更少,但末次随访时掌屈、旋前、旋后活动度较差,差异有统计学意义(P<0.05);2组末次随访时桡骨高度、掌倾角、尺偏角、腕关节功能Garland-Werley评分比较差异无统计学意义(P>0.05)。结论三柱理论指导下采用外固定架与锁定钢板内固定治疗AO-C型桡骨远端骨折均可取得较为满意的临床疗效,临床医师应根据患者的具体情况来制定合理的手术方案。

Objective To investigate the operation method and clinical effect of locking plate internal fixation and external fixaor in the treatment of AO type C distal radius fractures based on three column theory. Methods Forty patients with AO type C distal radius fractures were treated in our department from October 2014 to January 2017. Eighteen cases were treated with locking plate internal fixation（locking plate group） while 22 cases were treated with adjustable external fixator combined with limited internal fixation（external fixator group）. The duration of operation, intraoperative blood loss, and the radius height,volar tilt angle, ulnar inclination angle, range of motion of wrist joint, Garland-Werley score at the time of the latest follow-up were compared between the two groups. Results All cases were followed up for 13 months on average（from 6 months to 18 months）. All the fractures were healed within 3 months according to X-ray examination, none of them were accompanied with bone nonunion or bone atrophy. Compared with the group of locking plate, the group of external fixator was faster with less bleeding; However, there was a statistical difference between two groups in palmar flexion, pronation, and supination range of motion at the latest follow-up, the group of external fixator showed a little less（P〈0.05）. There was no statistical difference in the radius height, volar tilt angle, ulnar inclination angle, and Garland-Werley score of wrist join function at the latest follow-up between two groups（P〉0.05）. Conclusion Based on three column theory, the clinical effect of two methods are effective and satisfactory in the treatment of AO type C distal radius fractures. The surgeon should choose a reasonable method according to particular case of patient.