外固定支架治疗老年性桡骨远端C1型骨折的疗效及对骨折愈合、并发症的影响

Effect of external fixator in elderly distal radius C1-type fracture patients and its influence on fracture healing and complication

目的探讨外固定支架治疗老年性桡骨远端C1型骨折的疗效及对骨折愈合、并发症的影响。方法选择2012年7月至2015年12月在宜宾市第一人民医院就诊的80例桡骨远端C1型骨折患者,其中男性33例,女性47例;年龄61~76岁,平均年龄69.84岁;体质量指数(BMI)(25.06±3.17)kg/m^2。随机分为对照组和观察组,各40例。观察组男性16例,女性24例;年龄61~73岁,平均年龄69.23岁;BMI(24.18±2.09)kg/m^2。对照组男性17例,女性23例;年龄63~76岁,平均年龄69.75岁;BMI(24.52±2.63)kg/m^2。对照组给予掌侧锁定钢板内固定治疗,观察组给予外固定支架治疗。观察2组手术指标;采用Gartland-Werley计分法评价两组患者的腕关节功能;采用放射免疫法检测血清成骨指标含量并记录骨折愈合时间;记录随访期间并发症发生情况。结果观察组术中出血量、手术时间、住院时间分别为(44.27±6.82)m L、(22.59±4.87)min、(6.58±0.97)d,显著少于对照组[(83.42±9.19)m L、(59.08±8.92)min、(11.74±1.93)d],差异均有统计学意义(P<0.05)。术后6个月,观察组与对照组患者腕关节功能差异无统计学意义(P>0.05)。术后1个月,观察组骨碱性磷酸酶(BALP)水平[(56.73±5.95)U/L]、骨钙素(BGP)水平[(7.09±0.86)μg/L]与对照组[(39.52±4.09)U/L、(5.32±0.65)μg/L]相比较显著升高(P<0.05)。骨折愈合时间与对照组相比较,显著降低[(10.16±1.53)周vs(13.24±1.67)周;P<0.05]。对照组患者掌倾角(9.56°±0.81°)、尺偏角(21.39°±0.69°)、桡骨高度(9.55 mm±0.62 mm)均略大于观察组(分别为9.46°±1.02°、21.31°±0.58°、9.42 mm±0.36 mm),但差异均无统计学意义(P>0.05)。两组关节面台阶分级差异也无统计学意义(P>0.05)。两组并发症发生率差异无统计学意义(7.50%vs 10.00%;P>0.05)。结论外固定支架治疗老年性桡骨远端C1型骨折疗效确切,可缩短骨折愈合时间,具有临床推广价值。

Objective To study the effect of external fixator in elderly distal radius C1-type fracture patients and its influence on fracture healing and complications.MethodsFrom July 2012 to December 2015,a total of 80 distal radius C1-type fracture patients were enrolled,which included 33 males and 47 females,aged 61-76 years old with mean age of 69.84 years old;the body mass index（BMI）was（25.06±3.17）kg/m^2.All of them were randomly divided into observation group[n=40,included 16 males and 24 females;aged 61-73 years old with mean age of 69.23 years old;BMI was（24.18±2.09）kg/m^2]and control group[（n=40,included 17 males and 23 females;aged 63-76 years old with mean age of 69.75 years old;BMI was（24.52±2.63）kg/m^2].The volar locking plate internal fixation was performed in control group and external fixation in observation group.The surgical index of 2 groups were observed,Gartland-Werley scoring method was used to evaluate the wrist function of 2 groups.Radioimmunoassay was used to detect serum osteogenic index,fracture healing time was recorded.The complications during the follow-up were also recorded.Results The intraoperative bleeding volume[（44.27±6.82）mL],operation time[（22.59±4.87）minutes]and total hospitalization time[（6.58±0.97）days]of observation group were significantly less than those in control group[（83.42±9.19）mL,（59.08±8.92）minutes,（11.74±1.93）days,respectively]（P〈0.05）.Sixmonth after operation,there was no statistical difference between 2 groups in wrist function（P〉0.05）.One month after operation,the bone alkaline phosphatase（BALP）[（56.73±5.95）U/L],bone glaprotein（BGP）[（7.09±0.86）μg/L]of observation group were significantly higher than those of control group[（39.52±4.09）U/L,（5.32±0.65）μg/L]（P〉0.05）.The fracture healing time was significantly shorter than that of control group[（10.16±1.53）weeks vs（13.24±1.67）weeks;P〉0.05].In control group,the volar tilting angle[（9.56±0.81）°],ulnar angle[（21.39±0.69）°]and radial height[（9.55±0.62）mm were slightly larger than those of observation group[（9.46±1.02）°,（21.31±0.58）°,（9.42±0.36）mm],while there was no significant statistically difference between 2 groups（P〉0.05）.The articular surface grading and complications incidence（7.50%vs10.00%）between 2 groups were no significant difference（P〉0.05）.Conclusion It is demonstrated that external fixator in treatment of elderly distal radius C1-type fracture patients is effective,which could shorten fracture healing time and be widely applied.