球囊扩张复位外固定支架固定与切开复位锁定加压钢板内固定治疗骨质疏松性桡骨远端C型骨折的对比研究

A comparative study of balloon dilation reduction and frame external fixation versus open reduction and locking compression plate internal fixation for treatment of osteoporotic type-C fractures of distal radius

目的:比较球囊扩张复位外固定支架固定与切开复位锁定加压钢板内固定治疗骨质疏松性桡骨远端C型骨折的临床疗效和安全性。方法:2015年1月至2017年6月收治40例骨质疏松性桡骨远端C型骨折患者,随机分为2组,每组20例。球囊复位组采用球囊扩张复位联合外固定支架固定治疗,切开复位组采用切开复位锁定加压钢板内固定治疗。观察骨折愈合情况,记录治疗及随访期间的并发症发生情况。测定患者的握力恢复情况,按照改良Lidstrom量表评定骨折复位情况,以Gartland-Werley评分系统评定腕关节功能。结果:2组患者的手术时间、术中出血量比较,组间差异均无统计学意义[(55.00±6.37)min,(52.00±6.20)min,t=0.231,P=0.814;(32.00±5.44)mL,(40.00±11.68)mL,t=0.869,P=0.092]。所有患者均获得随访,随访时间12~25个月,中位数14个月。所有骨折均愈合。球囊扩张组未出现钉道感染、固定针松动、医源性骨折、骨水泥渗漏等并发症;切开复位组未发生切口感染、正中神经损伤及肌腱断裂等并发症。术后3个月时,2组患者的桡骨高度、掌倾角、尺偏角、握力、掌屈活动度、桡偏活动度、尺偏活动度、旋前活动度、旋后活动度及Gartland-Werley评分比较,组间差异均无统计学意义[桡骨高度:(11.13±2.17)mm,(10.82±2.61)mm,t=0.675,P=0.107;掌倾角:11.14°±2.26°,11.64°±1.86°,t=0.275,P=0.394;尺偏角:22.36°±3.01°,22.96°±2.89°,t=0.231,P=0.579;握力:(4.83±1.81)kg,(5.11±1.44)kg,t=0.493,P=0.152;掌屈活动度:39.05°±9.67°,36.91°±8.03°,t=0.871,P=0.081;桡偏活动度:15.37°±4.43°,14.61°±3.93°,t=0.392,P=0.267;尺偏活动度:24.69°±5.84°,25.36°±5.17°,t=0.383,P=0.283;旋前活动度:63.35°±9.19°,66.47°±9.32°,t=0.862,P=0.085;旋后活动度:60.36°±8.58°,60.85°±7.81°,t=0.254,P=0.510;Gartland-Werley评分:(5.98±2.71)分,(5.13±2.26)分,t=0.431,P=0.218];球囊复位组的关节面台阶和腕关节背伸活动度均小于切开复位组[(0.84±0.67)mm,(1.38±1.14)mm,t=4.812,P=0.007;29.11°±7.71°,38.36°±9.17°,t=5.374,P=0.006]。术后12个月时,2组患者的掌倾角、尺偏角、握力、掌屈活动度、背伸活动度、桡偏活动度及旋前活动度比较,组间差异均无统计学意义[掌倾角:11.26°±1.17°,11.58°±1.32°,t=0.224,P=0.629;尺偏角:22.17°±2.69°,22.86°±2.13°,t=0.275,P=0.394;握力:(8.42±1.88)kg,(8.51±1.52)kg,t=0.195,P=0.861;掌屈活动度:45.68°±4.91°,43.71°±3.73°,t=0.796,P=0.936;背伸活动度:50.37°±9.03°,50.84°±9.95°,t=0.210,P=0.725;桡偏活动度:18.41°±5.17°,19.10°±4.36°,t=0.372,P=0.306;旋前活动度:70.70°±8.91°,71.36±°7.36°,t=0.492,P=0.152];球囊复位组的桡骨高度高于切开复位组[(10.80±1.74)mm,(9.31±2.73)mm,t=3.930,P=0.009],关节面台阶低于切开复位组[(0.65±0.32)mm,(1.25±0.93)mm,t=5.287,P=0.006],尺偏活动度和旋后活动度均大于切开复位组(31.54°±4.39°,27.14°±6.07°,t=0.383,P=0.013;73.18°±8.25°,66.73°±7.71°,t=5.871,P=0.005),Gartland-Werley评分低于切开复位组[(1.58±1.11)分,(2.87±1.76)分,t=4.178,P=0.009]。结论:采用球囊扩张复位外固定支架固定治疗骨质疏松性桡骨远端C型骨折,能有效恢复桡骨远端关节面平整,患者腕关节功能恢复好,安全性高,中期疗效优于切开复位锁定加压钢板内固定治疗。

Objective:To compare the clinical curative effects and safety of balloon dilation reduction and frame external fixation versus open reduction and locking compression plate internal fixation in treatment of osteoporotic type-C fractures of distal radius.Methods:Forty patients with osteoporotic type-C fractures of distal radius were recruited from January 2015 to June 2017,and were randomly divided into balloon reduction group and open reduction group,20 cases in each group.The patients in balloon reduction group were treated with balloon dilation reduction and frame external fixation,while the patients in open reduction group were treated with open reduction and locking compression plate internal fixation.The fracture healing was observed,and the complication incidences were recorded during the treatment and follow-up period.The grip strengths of patients in the 2 groups were measured,and the fracture reduction and wrist joint function were evaluated according to modified Lidstrom scale and Gartland-Werley scoring system respectively.Results:There was no statistical difference in operative time and intraoperative blood loss between the 2 groups(55.00+/-6.37 vs 52.00+/-6.20 minutes,t=0.231,P=0.814;32.00+/-5.44 vs 40.00+/-11.68 mL,t=0.869,P=0.092).All patients in the 2 groups were followed up for 12-25 months with a median of 14 months,and all fractures healed in the 2 groups.No complications such as pin-track infection,pin loosening,iatrogenic fracture and bone cement leakage were found in balloon reduction group;while no complications such as incision infection,median nerve injury and tendon rupture were found in open reduction group.There was no statistical difference in radial height,volar tilt angle,radial inclination angle,grip strength,range of motions(ROM)of palmar flexion,radial deviation,ulnar deviation,pronation and supination of wrist and Gartland-Werley scores between the 2 groups at 3 months after the surgery(11.13+/-2.17 vs 10.82+/-2.61 mm,t=0.675,P=0.107;11.14+/-2.26 vs 11.64+/-1.86 degrees,t=0.275,P=0.394;22.36+/-3.01 vs 22.96+/-2.89 degrees,t=0.231,P=0.579;4.83+/-1.81 vs 5.11+/-1.44 kg,t=0.493,P=0.152;39.05+/-9.67 vs 36.91+/-8.03 degrees,t=0.871,P=0.081;15.37+/-4.43 vs 14.61+/-3.93 degrees,t=0.392,P=0.267;24.69+/-5.84 vs 25.36+/-5.17 degrees,t=0.383,P=0.283;63.35+/-9.19 vs 66.47+/-9.32 degrees,t=0.862,P=0.085;60.36+/-8.58 vs 60.85+/-7.81 degrees,t=0.254,P=0.510;5.98+/-2.71 vs 5.13+/-2.26 points,t=0.431,P=0.218).The joint surface step heights and dorsiflexion ROM of wrist were lower in balloon reduction group compared to open reduction group(0.84+/-0.67 vs 1.38+/-1.14 mm,t=4.812,P=0.007;29.11+/-7.71 vs 38.36+/-9.17 degrees,t=5.374,P=0.006).There was no statistical difference in volar tilt angles,radial inclination angles,grip strengths and ROMs of palmar flexion,dorsiflexion,radial deviation and pronation between the 2 groups at 12 months after the surgery(11.26+/-1.17 vs 11.58+/-1.32 degrees,t=0.224,P=0.629;22.17+/-2.69 vs 22.86+/-2.13 degrees,t=0.275,P=0.394;8.42+/-1.88 vs 8.51+/-1.52 kg,t=0.195,P=0.861;45.68+/-4.91 vs 43.71+/-3.73 degrees,t=0.796,P=0.936;50.37+/-9.03 vs 50.84+/-9.95 degrees,t=0.210,P=0.725;18.41+/-5.17 vs 19.10+/-4.36 degrees,t=0.372,P=0.306;70.70+/-8.91 vs 71.36+/-7.36 degrees,t=0.492,P=0.152).The radial heights were higher,and the joint surface step heights were lower,and the ROM of ulnar deviation and supination were greater,and the Gartland-Werley scores were lower in balloon reduction group compared to open reduction group(10.80+/-1.74 vs 9.31+/-2.73 mm,t=3.930,P=0.009;0.65+/-0.32 vs 1.25+/-0.93 mm,t=5.287,P=0.006;31.54+/-4.39 vs 27.14+/-6.07 degrees,t=0.383,P=0.013;73.18+/-8.25 vs 66.73+/-7.71 degrees,t=5.871,P=0.005;1.58+/-1.11 vs 2.87+/-1.76 points,t=4.178,P=0.009).Conclusion:The combination therapy of balloon dilation reduction and frame external fixation can effectively restore the smoothness of articular surface of distal radius,and patients can obtain good wrist joint function and high safety,and its mid-term curative effect is better than that of combination therapy of open reduction and locking compression plate internal fixation in treatment of osteoporotic type-C fractures of distal radius.