半环式外固定架治疗C型桡骨远端骨折

Semicircular external fixator for C-type distal radius fracture

[目的]探讨半环式外固定架治疗C型桡骨远端骨折的临床效果。[方法] 2016年6月～2017年6月收治的44例C型桡骨远端骨折患者用匹配配对的方法分为外固定组与内固定组,每组22例。外固定组采用半环式外固定架治疗,内固定组采用切开复位内固定治疗。比较两组患者围手术期观察指标、改良的Gartland-Werley腕关节评分、影像学解剖评分和测量数据。[结果]两组患者均顺利手术,术中均无血管、神经损伤等严重并发症。外固定组术中失血量显著少于内固定组,差异有统计学意义(P<0.05)。两组患者均经最少1年的随访。末次随访时,依据Gartland-Werley腕关节评分:外固定组优良率81.80%,内固定组优良率95.45%。两组差异无统计学意义(P>0.05)。Smilovic影像学评分外固定组优良率95.40%,内固定组优良率81.80%。两组间差异无统计学意义(P>0.05),外固定组掌倾角恢复显著优于内固定组(P<0.05)。[结论]半环式外固定架在治疗桡骨远端粉碎性骨折时,可同时兼顾对功能与解剖角度的恢复,尤其对于掌倾角度的恢复具有明显临床优势。

[Objective]To explore the clinical outcomes of semicircular external fixator for treatment of C-type distal radius fracture.[Methods]From June 2016 to June 2017,44 patients with C-type distal radius fracture were equally divided into two groups by matching pairs method,with 22 patients in each group.Of them,the patients in the external fixation(EF)group had fracture fixed with external fixator,while those in the internal fixation(IF)group received open reduction and internal fixation with plate and screws.The perioperative data,modified Gartland-Werley wrist score,imaging anatomic score and radiographic measurements were compared between the two groups.[Results]All the patients in both groups had operation performed smoothly without serious complications,such as neurovascular injuries,in anyone of them.The EF group had significantly less intraoperative blood loss than the IF group(P<0.05).The follow-up period lasted for more than 12 months.At the latest follow up,the EP group achieved the excellent and good rate of 81.80%,while the IF group was of 95.45%based on the Gartland-Werley wrist score,which proved had no statistically significant difference(P>0.05).In term of radiographic evaluation,the EF group had the excellent and good rate of 95.40%,whereas the IF group got the rate of 81.80%regarding to the Smilovic anatomic score,there was not statistically significant difference between the two group(P>0.05).Moreover,the EF group proved significantly superior to the IF group in restoration of the palm tilt angle(P<0.05).[Conclusion]For treatment of comminuted distal radius fractures,the semicircular external fixator does facilitate both functional and anatomical restoration,especially the palmar tilt angle.