腕关节外固定支架与锁定钢板内固定治疗桡骨远端C型骨折的疗效对比

Comparison of the effects of wrist external fixation and locking plate for the treatment of type C fracture of the distal radius

目的探讨腕关节外固定支架与锁定钢板内固定治疗桡骨远端C型骨折的疗效。方法前瞻性对照研究2016年4月—2019年4月南通大学第四附属医院骨科及南通大学附属医院创伤中心收治桡骨远端C型骨折患者96例,按照随机数字表法分为外固定组和内固定组,各48例。外固定组行外固定支架固定,内固定组行掌侧锁定钢板内固定。外固定组男性28例,女性20例;年龄22~76岁,平均43.3岁;道路交通伤28例,坠落伤8例,跌倒伤12例。内固定组男性30例,女性18例;年龄20~79岁,平均42.3岁;道路交通伤24例,坠落伤10例,跌倒伤14例。比较两组患者手术时间、术中出血量、住院时间、骨折愈合时间、尺偏角、掌倾角、桡骨高度以及术后腕关节功能;记录两组患者术后并发症的发生情况。结果外固定组手术时间(25.42±10.20)min、术中出血量(36.15±6.32)mL、住院时间(10.26±2.17)d以及骨折愈合时间(10.17±1.25)周等指标显著优于内固定组[手术时间(79.54±20.24)min、术中出血量(89.00±8.21)mL、住院时间(14.12±2.25)d、骨折愈合时间(11.24±1.63)周,P<0.05];两组患者术后尺偏角[(20.42±3.20)°vs.(21.54±3.24)°]、掌倾角[(10.15±2.32)°vs.(10.00±2.21)°]、桡骨高度[(13.26±1.17)mm vs.(13.12±1.25)mm]以及腕关节功能优良率(93.75%vs.91.67%)比较差异无统计学意义(P>0.05);两组腕关节功能评分各维度比较差异无统计学意义(P>0.05);内固定组并发症发生率8.3%,外固定组并发症发生率6.3%,两组比较差异无统计学意义(χ2=0.154,P=0.695)。结论外固定支架与锁定钢板内固定治疗桡骨远端C型骨折均可达到良好的治疗效果,但外固定支架治疗可减少患者创伤,加快骨折愈合,缩短住院周期,节约成本。临床需要根据实际情况以及患者意愿酌情选择治疗方式。

Objective To investigate the effect of wrist external fixation and locking plate internal fixation in the treatment of type C distal radius fractures.Methods A prospective controlled study was conducted in 96 patients with type C fracture of the distal radius who were treated in the Department of Orthopaedics,the Fourth Affiliated Hospital of Nantong University and the Trauma Center of the Affiliated Hospital of Nantong University from Apr.2016 to Apr.2019.They were randomly divided into external fixation group(48 cases)and internal fixation group(48 cases).There were 28 males and 20 females in the external fixation group;aged 22-76 years,with an average of 43.3 years;28 cases were road traffic injuries,8 cases were high-falling injuries,and 12 cases were falling injuries.In the internal fixation group,there were 30 males and 18 females;aged 20-79 years,with an average of 42.3 years;24 cases were road traffic injuries,10 cases were high-falling injuries,and 14 cases were falling injuries.The external fixation group was fixed with external fixation bracket,and the internal fixation group was fixed with volar locking plate for internal fixation.The operation time,intraoperative blood loss,hospital stay,fracture healing time,ulnar angle,palmar inclination angle,radial height and wrist joint function were compared between the two groups,and the incidence of postoperative complications was recorded.Results The operation time(25.42±10.20)min,intraoperative blood loss(36.15±6.32)mL,hospitalization time(10.26±2.17)days and fracture healing time(10.17±1.25)weeks in the external fixation group were significantly better than those in the internal fixation group[(79.54±20.24)min,intraoperative blood loss(89.00±8.21)mL,hospitalization time(14.12±2.25)days,fracture healing time(11.24±1.63)weeks(P<0.05)].There was no significant difference in postoperative ulnar deviation angle[(20.42±3.20)°vs.(21.54±3.24)°],palm angle[(10.15±2.32)°vs.(10.00±2.21)°],radial height[(13.26±1.17)mm vs.(13.12±1.25)mm]and the excellent and good rate of wrist joint function(93.75%vs.91.67%)between the two groups(P>0.05);there was no significant difference in wrist function score between the two groups(P>0.05);the incidence of complications in internal fixation group was 8.3%,which was 6.3%in the external fixation group(χ2=0.154,P=0.695).Conclusion Both external fixation and locking plate internal fixation can achieve good therapeutic effect in the treatment of type C distal radius fractures.However,external fixation can reduce trauma,accelerate fracture healing,shorten hospitalization period and save cost.In the actual clinical process,we need to choose the treatment according to the actual situation of patients and the wishes of patients.