手法复位石膏外固定与切开复位掌侧锁定钢板内固定治疗老年AO-C型桡骨远端骨折的比较

Comparison of treatment of elderly patients with AO-C type distal radius fractures by cast immobilization and open reduction internal fixation with volar locking plate

目的探讨手法复位石膏外固定与切开复位掌侧锁定钢板内固定治疗老年AO-C型桡骨远端骨折的临床疗效。方法选取2016年3月至2018年3月北京市顺义区医院收治的186例AO-C型桡骨远端骨折患者,56例行闭合手法复位石膏外固定(石膏组),130例行切开复位掌侧锁定钢板内固定术(手术组),比较两组骨折愈合时间、并发症、影像学资料及临床疗效。结果所有患者均获得至少12个月随访,骨折愈合时间两组比较差异无统计学意义[(11.3±1.4)周比(12.4±0.8)周,P=0.315];手术组出现并发症14例(10.8%),石膏组出现并发症16例(28.6%),差异有统计学意义(P<0.001);手术组复位效果(掌倾角、尺偏角)明显优于石膏组(P<0.001);手术组改良Gartland-Werley评分仅在术后3个月时优于石膏组(P<0.001),在术后6个月及12个月时两组功能评分差异无统计学意义(P>0.05)。结论与手法复位石膏外固定比较,切开复位掌侧锁定钢板内固定治疗老年AO-C型桡骨远端骨折可获得更好的骨折复位及早期(术后3个月)功能结果,但晚期(术后6个月和12个月)功能结果无明显优势。

Objective To investigate the clinical effect of manipulation reduction cast immobilization and open reduction internal fixation with volar locking plate on distal radius fractures of AO-C type in the elderly.Methods A total of 186 elderly patients with distal radius fractures of AO-C type were retrospectively analyzed from March 2016 to March 2018.Fiftysix patients were treated by cast immobilization in the emergency surgery room(plaster group),and 130 cases were treated by open reduction internal fixation with volar locking plate in the Department of Orthopedics(surgery group).The fracture healing time,complications,imaging data and clinical efficacy were compared between the two groups.Results All patients were followed up for at least 12 months.There was no significant difference in healing time between the two groups[surgery group(11.3±1.4)weeks vs.plaster group(12.4±0.8)weeks,P=0.315].Complications occurred in 14 patients in the surgery group(10.8%)and 16 patients in the plaster group(28.6%),the difference between the two groups was statistically significant(P<0.001).Reduction(palmar inclination and ulnar deviation)in the surgery group was significantly better than that in the plaster group,with statistically significant difference(P<0.001).The improved Gartland-Werley score in the surgery group was only superior to that in the plaster group at three months after surgery,with statistically significant difference(P<0.001),and no statistically significant difference in the functional score between the two groups at six months after surgery(P=0.184)and 12 months after surgery(P=0.149).Conclusions Compared with cast immobilization,open reduction internal fixation with locking plate for elderly patients with AO-C type distal radius fractures can achieve better reduction and early functional results(three months after surgery),but late(six months and 12 months after surgery)functional results have no obvious advantages.