掌背侧不同入路联合斜T形接骨板治疗桡骨远端C型骨折

The treatment of distal radius type C fracture with volar and dorsal approachs combined with oblique T-shaped plate

目的比较掌背侧不同手术入路治疗桡骨远端C型骨折的临床疗效。方法将43例桡骨远端C型骨折患者按骨块移位方向和骨折类型不同分为掌侧入路组(24例)和背侧入路组(19例),对两组骨折愈合情况、桡骨尺偏角、掌倾角、桡骨高度、腕关节活动度及功能进行比较。结果 43例均获得随访,时间8～15个月。骨折均愈合,骨折愈合时间两组比较差异无统计学意义(P> 0. 05)。术后1、6个月桡骨尺偏角、掌倾角、桡骨高度两组与术前比较差异均有统计学意义(P <0. 05),两组间比较差异无统计学意义(P> 0. 05);两组桡骨掌倾角术后6个月与术后1个月比较差异有统计学意义(P=0. 042)。末次随访时,腕关节背伸、掌屈、桡偏、尺偏、旋前、旋后活动度两组比较差异无统计学意义(P> 0. 05);两组腕关节功能优良率比较差异无统计学意义(P=0. 950)。结论掌背侧不同入路联合斜T形接骨板治疗桡骨远端C型骨折疗效相当。临床治疗中应按患者适应条件、骨折情况等确定个性化治疗方案。

Objective To compare the clinical effects of volar and dorsal surgical approaches for the treatment of distal radius type C fracture.Methods The 43 patients with distal radius type C fractures were divided into volar approach group(24 cases)and dorsal approach group(19 cases)according to the direction of bone displacement and fracture type.The fracture healing,radius ulnar deviation angle,volar inclination angle,radius height,wrist joint mobility and function were compared.Results All 43 patients were followed up for 8~15 months.All the fractures were healed,and there was no significant difference in the healing time between the two groups(P<0.05).At 1,6 months after operation,the differences between the two groups in radius ulnar deviation angle,volar inclination angle and radius height were statistically significant,compared with those before operation(P<0.05),while there was no significant difference between the two groups(P<0.05),there were statistically significant differences in volar inclination angle between the two groups at the sixth month and the first month after operation(P=0.042).At the last follow-up,the differences between the two groups in wrist dorsiflexion,palmar flexion,radial deviation,ulnar deviation,pronation and supination activity were not statistically significant(P<0.05);there was no significant difference in the excellent and good rate of wrist function between the two groups(P=0.950).Conclusions The treatment of distal radius type C fracture with volar and dorsal approachs combined with oblique T-shaped plate has similar curative effect.In clinical treatment,the individualized treatment plan should be based on the patient′s adaptation conditions and the conditions of fracture.