斜T型钢板内固定联合植骨在老年桡骨远端 C型骨折治疗中的应用

Application of oblique T-shaped plate internal fixation combined with bone grafting in the treatment of Type C Barton fracture in the elderly

目的研究斜T型钢板内固定联合植骨治疗老年桡骨远端C型骨折(TCBF)的效果。方法2014年7月—2018年6月成都医学院第一附属医院骨科治疗老年TCBF患者146例。依据治疗方法不同分为联合组(n=73)与外固定组(n=73)。联合组行斜T型钢板内固定联合植骨治疗,外固定组行外固定治疗。观察两组患者手术时间、术中出血量、骨折愈合时间、住院时间等手术相关指标,术后1年腕关节功能,术后1年腕关节尺偏、桡偏、掌屈、背伸、旋后及旋前角度等腕关节活动度指标,术前及术后1年桡骨高度、尺偏角及掌倾角,术前及术后7d血清P物质(SP)、五羟色胺(5-HT)、去甲肾上腺素(NE)等疼痛因子,并发症情况。结果术后1年,联合组腕关节功能优良率(84.93%)高于外固定组(69.86%,P<0.05)。联合组腕关节尺偏、桡偏、掌屈、背伸、旋后、旋前角度,桡骨高度、尺偏角及掌倾角均大于外固定组(P<0.05)。联合组SP、5-HT、NE水平均低于外固定组(P<0.05)。联合组并发症发生率(4.11%)低于外固定组(13.70%,P<0.05)。结论斜T型钢板内固定联合植骨治疗TCBF可恢复腕关节功能,缓解患者疼痛,优良率高,并发症少,值得临床应用。

Objective To study the effect of oblique T,shaped plate internal fixation combined with bone grafting in the treatment of type C Barton fracture(TCBF)of distal radius in the elderly.Methods Totally 146 elderly TCBF patients were treated in our hospital from Jul.2014 to Jun.2018.According to the random number table method,they were divided into experimental group(n=73)and control group(n=73).The experimental group was treated with oblique T,shaped plate internal fixation combined with bone grafting,while the control group was treated with external fixation.The operation time,intraoperative blood loss,fracture healing time,hospital stay and other operation related indexes;wrist joint function one year after operation;wrist joint movement indexes such as ulnar deviation,radial deviation,palmar flexion,dorsal extension,supination and pronation angle,radius height,ulnar deviation angle and palmar inclination angle one year before and after operation;serum P substance(SP),serotonin(5-HT),norepinephrine(NE)and other pain factors and complications before and 7 days after operation were observed.Results The excellent and good rate of wrist joint function in the experimental group was 84.93%,higher than that in the control group(69.86%,P<0.05).The wrist ulnar deviation,radial deviation,volar flexion,dorsal extension,supination,pronation angle,radius height,ulnar deviation angle and volar inclination angle in the experimental group were all higher than those in the control group(P<0.05).SP,5-HT and NE levels in the experimental group were lower than those in the control group(P<0.05).The incidence of complications in the experimental group(4.11%)was lower than that in the control group(13.70%,P<0.05).Conclusion Treatment of TCBF with oblique T,shaped plate internal fixation combined with bone grafting can restore wrist function and relieve pain in patients with high excellent and good rate and few complications,which is worthy of clinical application.