桡骨远端掌侧交叉锁定接骨板治疗FernandezⅢ~Ⅴ型桡骨远端闭合骨折的早期疗效

Early efficacy of distal volaris radius cross locking plate in the treatment of Fernandez typeⅢ-Ⅴclosed distal radius fractures

目的探讨桡骨远端掌侧(DVR)交叉锁定接骨板与外固定架治疗FernandezⅢ~Ⅴ型桡骨远端闭合骨折的早期疗效。方法选取2017年1月至2019年6月大连大学附属中山医院收治的76例桡骨远端闭合骨折患者作为研究对象,根据治疗方法不同分为DVR组与外架组,每组38例。DVR组采用DVR交叉锁定接骨板治疗,外架组采用外固定支架治疗,比较两组术后不同时间掌倾角、尺偏角、桡骨短缩高度和术中出血量、住院时间、骨折愈合时间、优良率及并发症发生率。结果术后12周,外架组掌倾角、尺偏角均小于术后2、6周,桡骨短缩高度长于术后2、6周,且术后6周,尺偏角均小于术后2周,桡骨短缩高度长于术后2周,差异有统计学意义(P<0.05);术后6、12周,DVR组尺偏角均小于术后2周,差异有统计学意义(P<0.05),两组内其他时间点各指标两两比较差异无统计学意义。术后2、6、12周,DVR组掌倾角、尺偏角均大于外架组,桡骨短缩高度均短于外架组,差异有统计学意义(P<0.05)。两组术中出血量、住院时间、骨折愈合时间比较差异无统计学意义。DVR接骨板组优良率为94.73%,高于外架组的71.05%,差异有统计学意义(P<0.05)。DVR组并发症发生率为5.26%,明显低于外架组的23.68%,差异有统计学意义(P<0.05)。结论DVR交叉锁定接骨板内固定治疗桡骨远端闭合骨折疗效显著,能有效支撑关节面,维持患者折端的复位,且并发症少,患者进行早期功能锻炼,更利于腕关节功能恢复,值得临床推广应用。

Objective To investigate the early efficacy of distal volaris radius(DVR)cross locking bone plate in the treatment of Fernandez typeⅢ-Ⅴclosed distal radius fractures.Methods 76 patients with closed distal radius fractures admitted to Affiliated Zhongshan Hospital of Dalian University from January 2017 to June 2019 were selected as the research subjects,and they were divided into the DVR group and the external frame group according to the different treatment methods,with 38 cases in each group.The DVR group was treated with DVR cross locking bone plate,and the external frame group was treated with external frame,the volar tilt angle,ulnar deviation angle,radial shortening height at different time after operation and intraoperative blood loss,hospitalization time,fracture healing time,excellent and good rate and complication rate were compared between the two groups.Results At 12 weeks after operation,the palmar tilt angle and ulnar deviation angle in the external frame group were smaller than those at 2 and 6 weeks after operation,and the shortening height of the radius was longer than that at 2 and 6 weeks after operation,and at 6 weeks after operation,the ulnar deviation angle was smaller than that at 2 weeks after operation,and the shortening height of the radius was longer than that at 2 weeks after operation,the difference was statistically significant(P<0.05);at 6 and 12 weeks after operation,the ulnar deviation angle in the DVR group was smaller than that at 2 weeks after operation,and the differences were statistically significant(P<0.05),there was no sig-nificant difference in each index between the two groups at other time points.At 2,6 and 12 weeks,the palmar tilt angle and ulnar deviation angle in the DVR group were larger than those in the outer frame group,and the shortening height of the radius was shorter than that in the external frame group,the differences were statistically significant(P<0.05).There was no significant difference in intraoperative blood loss,hospitalization time and fracture healing time between the two groups.The excellent and good rate in the DVR plate group was 94.73%,which was higher than 71.05%in the external frame group,and the difference was statistically significant(P<0.05).The incidence in complications in the DVR group was 5.26%,which was significantly lower than 23.68%in the external frame group,and the difference was statistically significant(P<0.05).Conclusion DVR cross locking plate internal fixation is effective in the treatment of closed distal radius fractures,it can effectively support the articular surface,main-tain the reduction of the patient's broken end,and has fewer complications,early functional exercise is more conducive to the recovery of wrist func-tion,and is worthy of clinical promotion and application.