老年桡骨远端关节内骨折保守与掌侧锁定钢板手术治疗的疗效比较

Comparison of conservative treatment and volar locking plate surgery in treating intra-articular distal radius fractures in elderly patients

目的比较保守与掌侧锁定钢板手术治疗老年桡骨远端关节内骨折的关节活动度及功能评分。方法回顾性研究2017年1月至2019年12月期间于北京大学首钢医院骨科进行治疗的桡骨远端关节内骨折患者,共75例。其中33例患者采用手法复位及石膏外固定治疗,42例患者采用掌侧锁定钢板手术治疗,根据2组患者治疗后12个月的腕关节活动度及上肢功能损伤(DASH)评分评价其疗效。结果保守组患者关节活动度:背伸(60.7±7.2)°;掌屈(53.6±10.5)°;旋前(83.9±8.9)°;旋后(83.8±7.7)°;桡偏(23.2±8.1)°;尺偏(36.2±7.8)°;DASH评分(11.1±9.4)分。手术组患者关节活动度:背伸(58.2±9.4)°;掌屈(50.1±10.0)°;旋前(83.1±8.8)°;旋后(83.9±8.4)°;桡偏(22.8±7.0)°;尺偏(37.5±7.4)°;DASH评分(9.8±10.8)分,2组间比较差异无统计学意义(P>0.05)。结论保守和掌侧锁定钢板均为治疗老年桡骨远端关节内骨折的有效治疗手段,二者间无明显治疗差异,临床治疗中应根据患者具体情况,选择合适的治疗方式。

Objective To compare the range of motion and functional scores of distal radius intraarticular fractures in elderly patients after conservative and volar locking plate surgery.Methods A total of 75 patients with intra-articular fractures of the distal radius treated at Peking University Shougang Hospital from January 2017 to December 2019 were retrospectively studied.Among them,33 patients were treated by manual reduction and plaster external fixation,and 42 patients were treated by volar locking plate surgery.The efficacy of the two groups was evaluated by wrist motion and Disabilities of the Arm,Shoulder and Hand(DASH)score at 12 months after treatment.Results The parameters of range of motion in the conservative group were the following:dorsiflexion,(60.7±7.2)°;palmar flexion,(53.6±10.5)°;pronation,(83.9±8.9)°;supination,(83.8±7.7)°;radial deviation,(23.2±8.1)°;ulnar deviation,(36.2±7.8)°;DASH score,11.1±9.4;the corresponding parameters in the operation group were(58.2±9.4)°,(50.1±10.0)°,(83.1±8.8)°,(83.9±8.4)°,(22.8±7.0)°,(37.5±7.4)°,and(9.8±10.8).There was no significant difference in these parameters between the two groups(P>0.05).Conclusion Both conservative treatment and volar locking plate surgery are effective in the treatment of intra-articular fractures of the distal radius in the elderly.There is no significant difference between the two.The appropriate treatment should be selected according to the specific conditions of patients.