桡侧辅助钢板治疗外侧柱不稳定型桡骨远端骨折的临床效果分析

Clinical Efficacy Analysis of Radial Assistant Plate in the Treatment of Distal Radial Fractures with Unstable Lateral Column

目的:探讨桡侧辅助钢板联合掌侧锁定钢板在内固定治疗外侧柱不稳定型桡骨远端骨折的临床效果。方法:选取2019年1月-2020年2月本院的外侧柱不稳定型桡骨远端骨折患者48例。将患者随机分为A组(n=30)和B组(n=18)。A组采用掌侧T型锁定钢板治疗,B组采用桡侧辅助钢板联合掌侧T型锁定钢板治疗。分析手术前后影像学指标及术后患者腕关节活动度、Gartland-Werley评分。结果:两组术后1个月的尺偏角比较,差异无统计学意义(P>0.05);两组术后1个月的掌倾角,差异有统计学意义(P<0.05)。术后3个月,A组的优良率为90.0%,与B组的94.4%比较,差异无统计学意义(P>0.05)。术后3个月,两组的桡偏、尺偏活动度比较,差异均无统计学意义(P>0.05);B组背伸、掌屈、旋前、旋后的活动度均明显优于A组,差异均有统计学意义(P<0.05)。A组有4例患者术后出现骨折复位丢失;B组术后复查未见明显复位丢失,但有1例术后出现桡神经浅支牵拉伤,虎口区麻木,口服弥可保2周后症状消失。结论:采用桡侧辅助钢板联合掌侧锁定钢板可有效治疗外侧柱不稳定型桡骨远端骨折,重建桡骨远端正常解剖并实现骨折的坚强固定、避免术后复位丢失,便于患肢的早期功能锻炼,疗效较单掌侧钢板螺钉内固定治疗更为显著。

Objective:To investigate the clinical effect of radial auxiliary plate combined with volar locking plate internal fixation in the treatment of unstable distal radius fractures of lateral column.Method:A total of 48 patients with lateral column unstable distal radius fractures in our hospital from January 2019 to February 2020 were selected.Patients were randomly divided into group A(n=30)and group B(n=18).Group A was treated with volar T-type locking plate,and group B was treated with radial auxiliary plate combined with volar T-type locking plate.Imaging indexes,wrist range of motion and Gartland-Werley score were analyzed before and after surgery.Result:There was no significant difference in ulnar declination angle between the two groups 1 month after surgery(P>0.05).There was significant difference in palmar angle between the two groups 1 month after surgery(P<0.05).3 months after surgery,the excellent and good rate of group A was 90.0%,compared with 94.4% of group B,the difference was not statistically significant(P>0.05).3 months after surgery,there were no significant differences in radial deviation and ulnar deviation activity between the two groups(P>0.05).The range of motion of dorsal extension,palm-flexion,pronation and supination in group B were significantly better than those in group A,the differences were statistically significant(P<0.05).In group A,4 patients showed loss of fracture reduction after operation.Postoperative reexamination of group B showed no obvious reduction loss,but there was 1 patient with superficial radial nerve pull injury and numbness in the mouth area,and the symptoms disappeared 2 weeks after oral administration of microrba.Conclusion:The radial auxiliary plate combined with the volar locking plate can effectively treat the unstable distal radius fracture of the lateral column,reconstruct the normal anatomy of the distal radius and achieve the strong fixation of the fracture,avoid postoperative reduction and loss,facilitate the early functional exercise of the affected limb,and the effect is more significant than the treatment of the single volar plate and screw internal fixation.