掌侧锁定接骨板与附加克氏针外固定治疗桡骨远端AO C2/C3型骨折的对比研究

Retrospective comparative study of volar locking plate and external fixation with Kirschner wire in the treatment of AO type C2/C3 fractures of distal radius

目的比较掌侧锁定接骨板(volar locking plate, VLP)和外固定支架(external fixation, EF)治疗桡骨远端AO C2/C3型骨折的影像学和治疗效果。方法自2017年1月至2020年3月我们共收治62例AO C2/C3型桡骨远端骨折患者, 其中23例接受EF治疗, 39例接受VLP治疗。采用Gartland-Werley量表和上肢功能障碍评定量表(Disability of Arm Shoulder and Hand, DASH)评价总体治疗效果与功能恢复情况, 测量腕关节活动度和握力, 影像学参数包括掌倾角、尺偏角、桡骨长度、尺骨变异和关节面台阶。所有统计学分析均采用SPSS 21.0统计软件。结果两组患者在年龄、性别、受伤侧别、是否优势手、致伤原因、手术时间、是否植骨和随访时间方面差异无统计学意义(P>0.05)。术后随访时间为12~47个月, 平均17.1个月。末次随访时, VLP组在腕关节屈曲(VLP组69.7°、EF组62.3°, P<0.001)、前臂旋前(VLP组73.1°、EF组64.8°, P=0.027)和旋后(VLP组70.6°、EF组63.1°, P=0.033)角度方面恢复优于EF组, 其他关节活动范围参数两组差异无统计学意义(P>0.05)。两组的Gartland-Werley和DASH评分差异无统计学意义(P>0.05)。末次随访X线片显示, VLP组的尺骨变异为(0.6±1.3) mm, EF组为(1.6±1.8) mm, 差异有统计学意义(P=0.002);VLP组的关节阶梯为(0.5±1.1) mm, 其改善明显优于EF组(1.2±1.4) mm, 差异有统计学意义(P=0.007)。两组总体并发症发生率分别为VLP组的28.2%和EF组的34.5%, 差异无统计学意义(P=0.587)。结论 VLP固定在腕关节活动度(屈曲、旋前和旋后)、尺骨变异矫正和改善关节一致性方面表现出比EF固定更好的性能。

Objective To compare the radiographic and clinical efficacy of volar locking plate(VLP)and external fixation(EF)in the treatment of AO type C2/C3 fractures of distal radius.Methods From January 2017 to March 2020,we treated 62 patients with AO type C2/C3 fractures of distal radius,including 23 patients treated with EF and 39 patients treated with VLP.Gartland-Werley scale and upper limb dysfunction rating scale(Disability of Arm Shoulder and Hand,DASH)were used to evaluate the overall treatment effect and functional recovery.The wrist range of motion and grip strength were measured.The radiographic parameters included volar inclination,ulnar deviation,radius length,ulnar variation and articular surface step.SPSS 21.0 statistical software was used for all statistical analysis.Results There was no significant difference in age,sex,injured side,dominant hand,cause of injury,operation time,bone grafting and follow-up time between the two groups(P>0.05).The follow-up time was 12 to 47 months with an average of 17.1 months.At the last follow-up,the recovery of wrist flexion(69.7°in VLP group and 62.3°in EF group,P<0.001),forearm pronation(73.1°in VLP group and 64.8°in EF group,P=0.027)and supination(70.6°in VLP group and 63.1°in EF group,P=0.033)in VLP group was better than that in EF group,and there was no significant difference in other joint range parameters between the two groups(P>0.05).There was no significant difference in Gartland-Werley and DASH between the two groups(P>0.05).The last follow-up X-ray showed that the ulnar variation in VLP group was(0.6±1.3)mm and that in EF group was(1.6±1.8)mm.Their difference was statistically significant(P=0.002).The joint ladder of VLP group was(0.5±1.1)mm,which was significantly better than that of EF group(1.2±1.4)mm(P=0.007).The overall.complication rates of the two groups were 28.2%in VLP group and 34.5%in EF group,respectively.There was no significant difference(P=0.587).Conclusion The VLP fixation has better performance than EF fixation in wrist range of motion(flexion,pronation and supination),correction of ulnar variation and improvement of joint consistency.