球囊扩张骨水泥填充联合外固定支架治疗骨质疏松性桡骨远端C型骨折的疗效观察

目的比较球囊扩张结合硫酸钙骨水泥与外固定支架治疗骨质疏松性桡骨远端C型骨折的临床疗效.方法2015年1月至2017年6月骨质疏松性桡骨远端C型骨折40例,其中外固定支架固定20例(EF组),球囊扩张骨水泥填充联合外固定支架固定20例(球囊组).比较两种方法术后3个月、1年患者的握力、改良Lidstrom评分和经典Gartland-Werley评分,并进行疗效评定.结果骨折均获愈合,愈合时间8~l4周.近期、远期疗效均显示球囊组桡骨高度、关节面台阶、握力、腕关节尺偏、旋后活动度及Gartland-Werley评分优于EF组(P<0.05).球囊组有2例发生硫酸钙骨水泥渗漏,均渗漏至骨折端前方肌肉内,术后逐渐吸收,未引起明显临床症状.结论采用球囊扩张骨水泥填充联合外固定支架固定治疗骨质疏松性桡骨远端C型骨折,骨折复位理想,固定可靠,腕及手部功能恢复满意,且临床并发症少,疗效显著.但存在一定的硫酸钙骨水泥渗漏风险,需谨慎操作.

Objective To compare the clinical efficacy of calcium sulfate cement-assisted balloon osteoplasty and external fixation(EF)in treating osteoporotic Type C fracture of distal radius.Methods From 2015.1 to 2017.6,40 patients with osteoporotic Type C fracture of distal radius were treated with calcium sulfate cement-assisted balloon osteoplasty and EF,wherein EF was used in 20 cases,and calcium sulfate cement-assisted balloon osteoplasty was used in 20.The therapeutic effects were evaluated by the power of gripping and modified Lidstrom score,classical Gartland-Werley score.Results All the fractures were healed,and the healing time was 8~14 weeks.Short-term and Long-term results showed:the height of radius,step of articular surface,gripping power,wrist ulnar deviation,pronation motion and classical Gartland-Werley score in balloon osteoplasty group were better than those in EF group(P<0.05).In balloon osteoplasty group,calcium sulfate cement leakage occurred in 2 cases,all of them were leaking into the anterior muscle of the fracture,and gradually absorbed after operation,without any obvious clinical symptoms.Conclusion The treatment of osteoporotic type C fracture of distal radius with calcium sulfate cement-assisted balloon osteoplasty is ideal,reliable fixation,satisfactory recovery of wrist and hand function,and less clinical complications.But there is a certain leakage risk of calcium sulfate bone cement,which needs careful operation.