双柱双钢板内固定与外固定架治疗桡骨远端骨折患者的疗效比较

Comparison of the Effect of Internal Fixation and External Fixation with Double-columns and Double-plates in Treatment of Distal Radius Fractures

目的比较双柱双钢板内固定与外固定架治疗桡骨远端C型骨折患者的疗效。方法选取2017年1月至2018年12月在佛山市中医院骨科住院接受手术治疗的60例桡骨远端C型骨折患者,按照随机数字表法分为观察组及对照组,每组30例。观察组予掌侧或掌背侧联合入路切开复位双柱双钢板内固定术,对照组采用闭合复位支架外固定术。分别于术前及术后3、6、12个月复查桡骨掌倾角、尺偏角及桡骨高度值变化情况,同时采用Gartland-Werley进行腕关节功能评分,记录两组手术时间、骨折愈合时间及并发症发生情况。结果两组均未出现病例脱落情况。两组患者的手术时间、骨折愈合时间比较,差异无统计学意义(P>0.05)。两组患者在术后3、6、12个月的掌倾角、尺偏角及桡骨高度均提高,差异有统计学意义(P<0.05);且观察组术后3、6、12个月的掌倾角、尺偏角及桡骨高度均高于对照组,差异有统计学意义(P<0.05)。观察组患者在术后3、6个月的Gartland-Werley评分均显著高于对照组,差异有统计学意义(P<0.05);在术后12个月,两组Gartland-Werley评分比较差异无统计学意义(P>0.05)。两组患者术后并发症总发生率比较,差异无统计学意义(P>0.05)。结论双柱双钢板技术治疗AO-C型桡骨远端骨折患者较外固定架更为牢靠,能更好的恢复桡骨高度、掌倾角及尺偏角,短期临床效果显著,有助于患者早期开展腕关节功能锻炼。

Objective To compare the efficacy of double-column double-plate internal fixation and external fixation for patients with type C fractures of the distal radius.Methods A total of 60 patients were hospitalized in the department of orthopedics,Foshan Traditional Chinese Medicine Hospital from January 2017 to December 2018,and were randomly divided into an observation group and a control group according to the random number table method,with 30 cases in each group.The observation group received open reduction and double-post double-plate internal fixation combined with palmar or dorsal palmar approach,and the control group used open reduction stent external fixation.The radial palmar inclination,ulnar declination and radial height values were reviewed at outpatient clinics before and 3,6,and 12 months after surgery,and Gartland-Werley was used to score the wrist joint function.The operation time,fractures healing time and incidence of complications of the two groups were recorded and compared.Results There was no case shedding in the two groups.There was no significant difference in the operation time and fracture healing time between the two groups of patients(P>0.05).The palmar angle,ulnar angle and radius height of the two groups of patients increased at 3,6,and 12 months after surgery,and the difference was statistically significant(P<0.05);and the observation group at 3,6,and 12 months after surgery palm inclination,ulnar deflection and radius height were all higher than those of the control group,and the difference was statistically significant(P<0.05).The Gartland-Werley scores of the observation group were significantly higher than those of the control group at 3 and 6 months after surgery,the difference was statistically significant(P<0.05);at 12 months after surgery,there was no difference in Gartland-Werley scores between the two groups,with statistical significance(P>0.05).There was no significant difference in the total incidence of postoperative complications between the two groups(P>0.05).Conclusion The treatment of AO-C type distal radius fractures with double-column double-plate technology is more reliable than external fixators,and can better restore radius height,palm inclination and ulnar deflection.It has significant short-term clinical effects and helps patients to early exercise of wrist joint function.