外固定支架治疗高龄桡骨远端粉碎性骨折的疗效分析

Efficacy of external fixation in the treatment of elderly patients with distal radius comminuted fractures

目的观察外固定支架治疗高龄桡骨远端粉碎性骨折患者的疗效。方法回顾性分析2013年9月至2016年3月我院收治的70岁以上采用外固定支架治疗的桡骨远端粉碎性骨折患者47例(48侧),随访6~18个月,术后4个月评价影像学骨折愈合结果,术后6个月评价患肢腕关节功能。结果术后2~4个月46例(47侧)患者骨折一期愈合,1例(1侧)患者延迟愈合;患者平均掌倾角12.3°、尺偏角22°、桡骨高度10.3 mm;影像学结果Lidstrom分级显示:Ⅰ级16例16侧,Ⅱ级19例20侧,Ⅲ级9例9侧,Ⅳ级3例3侧;术后6个月患侧腕关节功能PRWE评分结果显示:优18例19侧,良20例20侧,可6例6侧,差3例3侧,优良率为81.25%;共有6例7侧患者发生钉道感染,2例2侧发生克氏针退针,1例1侧桡骨钉孔处骨折。结论外固定支架治疗高龄桡骨远端粉碎性骨折患者优良率高,并发症少,是一种可靠的治疗方法。

Objective To discuss the effect of external fixation in the treatment of elderly patients with distal radius comminuted fractures. Methods The clinical data of 48 sides of 47 patients who aged over 70 years with distal radius comminuted fractures treated by external fixation in our hospital from September 2013 to March 2016 were retrospectively reviewed. The patients were followed up for 6~18 months. Four months after operation, fracture healing result was evaluated by X-ray. Six months after operation, limb wrist function was evaluated by PREW score.Results Fouty-seven sides of 46 patients were healed by first intention during 2~4 months after operation, and 1 side of1 patient had delayed healing. The patients' palm dip, radial inclination and radius height were respectively 12.3°, 22°and 10.3 mm in average. Imaging results of Lidstrom grading showed that there were 16 sides of 16 patients of gradeⅠ,20 sides of 19 patients of grade Ⅱ, 9 sides of 9 patients of grade Ⅲ, 3 sides of 3 patients of grade Ⅳ. Six months after surgery, the wrist function of PRWE score were excellent in 19 sides of 18 patients, good in 20 sides of 20 patients, fair in 6 sides of 6 patients, poor in 3 sides of 3 patients, with the excellent rate was 81.25%. Seven sides of 6 patients had pin tract infection, 2 side of 2 patients' had Kirschner needle retraction, and 1 side of 1 patient was occurred radius fracture on the pin tract. Conclusion External fixation in the treatment of elderly patients with distal radius comminuted fractures has high excellent and good postoperative complications, which is a reliable treatment method.