掌侧单钢板内固定治疗背侧移位桡骨远端不稳定型骨折的临床效果

Clinical effect of palmar single plate internal fixation in the treatment of unstable distal radius fractures with dorsal displacement

目的探讨掌侧单钢板内固定治疗背侧移位桡骨远端不稳定型骨折的临床效果。方法选择2018年7月至2020年8月该院收治的背侧移位桡骨远端不稳定骨折患者95例。按照随机数字表法分为2组,观察组47例,对照组48例,对照组行掌背侧入路双钢板内固定治疗,观察组行掌侧单钢板内固定治疗,比较2组手术操作时间、术后住院时间和骨折愈合时间,统计术前、术后48 h、出院时及术后6个月疼痛数字评分(NRS)变化,及出院时、术后1个月和术后6个月腕关节Cooney评分变化,统计2组术后常见并发症发生情况,比较术后6个月2组桡骨掌倾角、尺偏角、高度及腕关节活动度。结果观察组手术操作时间短于对照组(P<0.05),术后住院时间短于对照组(P<0.05),骨折愈合时间早于对照组(P<0.05)。术后48 h、出院时及术后6个月,观察组疼痛NRS均显著低于对照组(P<0.05);观察组出院时、术后1个月和术后6个月,腕关节Cooney评分均显著高于对照组(P<0.05)。观察组总的并发症发生率显著低于对照组(P<0.05),观察组桡骨掌倾角、尺偏角、高度均显著大于对照组,且旋前、旋后、背伸和屈曲角度也显著大于对照组(P<0.05)。结论桡骨远端不稳定骨折行掌侧单钢板固定术创伤小,更利于患者术后腕关节功能恢复,减少术后慢性疼痛发生率,且并发症少,安全性高。

Objective To investigate the clinical effect of palmar single plate internal fixation in the treatment of unstable distal radius fractures with dorsal displacement.Methods A total of 95 cases with unstable distal radius fractures with dorsal displacement from July 2018 to August 2020 were divided into two groups by the method of random number table method,the observation group(n=47)and the control group(n=48).The control group was treated with double-plate internal fixation via dorsal palmar approach,while the observation group was treated with single-plate internal fixation.Then the operation time,postoperative hospital stay and fracture healing time of the two groups were compared.The changes of numerical rating scale(NRS)scores of pain before operation,48 hours after operation,at discharge and six months after operation and Cooney scores of wrist joints at discharge,one month after operation and six months after operation were counted.The common postoperative complications of the two groups were counted.The palmar tilt,ulnar deviation angle,height and wrist range of motion were compared between the two groups six months after operation.Results The operation time,hospitalization time and fracture healing time in the observation group were shorter than those of the control group(P<0.05).The pain NRS scores of the observation group were significantly lower than those of the control group at 48 hours after operation,at discharge and six months after operation(P<0.05).The Cooney scores of wrist joint in the observation group were significantly higher than those of the control group at discharge,one month after operation and six months after operation(P<0.05),while the total proportion of common postoperative complications in the observation group was significantly lower than that of the control group(P<0.05).The palmar tilt,ulnar deviation angle and height in the observation group were significantly higher than those of the control group,while the angles of pronation,supination,dorsiflexion and flexion were significantly higher than those of the control group(P<0.05).Conclusion Palmar single plate fixation for unstable distal radius fractures is less traumatic,which is more conducive to the recovery of wrist function after operation.It can reduce the incidence of chronic pain after operation,and has few complications and high safety.