桥接式动力型外固定支架结合克氏针固定治疗桡骨远端C型骨折的临床观察

Clinical observation on the treatment of type C fracture of the distal radius with bridge dynamic external fixation bracket and Kirschner wire fixation

目的为了减少、避免腕关节僵硬,前瞻性研究桡骨远端C型骨折闭合复位并以桥接式动力型外固定支架(以下简称动力型支架)及克氏针固定治疗的临床疗效及应用价值。方法选择2012年1月—2017年2月在江苏省苏北人民医院骨科和扬州市广陵区中医院骨科诊治的桡骨远端AO分型为C型的骨折病例48例为研究对象,按随机数字法将所有患者平均分为观察组和对照组两组,每组各24例。观察组采用动力型支架结合克氏针治疗,对照组采用传统双球头关节腕关节外固定支架(以下简称传统支架)治疗。观察组术后使腕关节早期伸屈功能锻炼,对照组腕关节持续性固定;两组均术后2周行功能位固定,术后6～8周去除内外固定物强化腕关节功能锻炼。结果影像学采用Stewart改良的Sarmiento评分系统评估骨性愈合时间、掌倾角、尺偏角;同时检查患侧腕关节的屈曲度、背伸度、桡偏活动度,采用腕关节功能的Robbins评分进行评价。X片影像学检查,观察组的骨折部位骨性愈合时间、掌倾角度、尺偏角度均与对照组差异不明显(P>0.05)。两组患者的尺偏、桡偏差异不明显(P均>0.05);但观察组腕关节的背伸、掌屈、旋前、旋后功能都高于对照组,差异明显(P<0.05)。Robbins评分,观察组的评分明显高于对照组,差异明显(P<0.05)。两组未出现针道感染、骨折块移位、内外固定物松动、神经损伤、废用性骨萎缩并发症。结论桡骨远端C型骨折闭合复位,动力型支架结合克氏针内固定疗法比传统支架外固定疗法更能有效减轻、避免腕关节僵硬,是一种较好的治疗方法。

Objective In order to reduce and avoid the anchylosis,the study prospectively study the clinical effect and application value of treating type C fracture of distal radius with bridge dynamic external fixation bracket( hereinafter referred to as dynamic bracket) and Kirschner needle fixation.Methods From January 2012 to February 2017,48 patients with type C fractures were selected from department of orthopaedics of Subei people’s hospital and hospital of TCM of Guangling district in Yangzhou city.According to the random number method,the 48 patients were divided into observation group and control group,24 cases in each group. The observation group was treated with dynamic external bracket and Kirschner needle. The control group was treated with traditional external bracket of double ball joint wrist joint( hereinafter referred to as traditional bracket).The wrist extension and flexion function was performed early after operation in the observation group,and the wrist joint was fixed continuously in the control group.The functional position fixation was performed at 2 weeks after operation in both groups,and the external and internal fixations were removed 4 to 6 weeks after operation to strengthen the wrist function exercise.Results The bone healing time,palmar inclination angle and ulnar angle were evaluated by Stewart modified Sarmiento scoring system.At the same time,the flexion degree,dorsal extension degree,radial deviation activity of the affected wrist joint was examined by using the robbins score system. X ray imaging examination showed that the bone healing time,palmar inclination angle and ulnar angle of fracture site were observed in the observation group.There was no significant difference between the two groups( P>0.05).There was no significant difference in ulnar deviation and radial deviation between the two groups( P > 0. 05). But the wrist function of the observation group was higher than that of the control group( P < 0. 05). The robbins score of the observation group was significantly higher than that of the control group( P < 0. 05). No needle infection,displacement of fracture block,loosening of internal and external fixation,nerve injury and bone atrophy were observed in the two groups. Conclusions Closed reduction of type C fracture of distal radius,dynamic external bracket combined with Kirschner needle internal fixation is more effective than traditional external fixation.It is a better method to avoid wrist stiffness.