摘要
目的探讨桡骨远端C型骨折行外固定支架和锁定钢板内固定治疗的临床应用效果,以期为桡骨远端C型骨折的治疗提供参考。方法选择2015年1月至2017年1月期间云南省第二人民医院收治的桡骨远端C型骨折患者90例为本研究对象,将入选患者按随机数字表法分为观察组和对照组,每组患者45例。观察组患者行外固定支架手术治疗,对照组患者采用锁定钢板内固定手术治疗。对2组患者的手术情况指标包括手术时间、术中失血量、术后住院时间、骨折愈合时间等进行统计比较。同时对2组患者在术后出现的并发症的种类和发生率进行统计对比,评价2组手术治疗方法的安全性。并且对2组患者出院后进行为期12个月的随访观察,对2组患者术后的掌倾角、尺偏角、桡骨高度进行影像学测量比较。采用Gartland-Werly腕关节评分系统对2组患者术后的腕关节恢复功能进行评分比较。结果(1)观察组患者在手术进行及术后恢复指标包括手术时间、术中失血量、住院时间、骨折愈合时间分别为(28.91±8.37)min、(69.35±11.82)mL、(6.21±1.23)d、(47.12±11.35)d,均低于对照组相应指标分别为(54.42±9.85)min、(95.07±17.64)mL、(11.08±2.36)d、(68.30±14.02)d,组间比较差异有统计学意义(P<0.05);(2)观察组患者术后并发症发生率为6.67%(3/45),低于对照组并发症发生率22.22%(10/45),组间差异具有统计学意义(P<0.05);(3)在第12个月随访观察时,观察组患者影像学检查测量的掌倾角、尺偏角、桡骨高度分别为(10.13±1.48)°、(20.11±2.09)°、(10.03±1.87)mm,对照组相应指标分别为(10.67±1.59)°、(20.59±2.31)°、(9.86±1.91)mm,组间比较差异无统计学意义(P<0.05);(4)观察组在术后6个月、 12个月Gartland-Werly腕关节评分为(6.21±1.98)分、(2.71±0.95)分,高于对照组相应评分(4.06±1.54)分、(2.23±0.63)分,组间比较差异有统计学意义(P<0.05)。结论外固定支架与锁定钢板内固定均能治疗桡骨远端C型骨折,骨折愈合和腕关节功能恢复良好,但外固定支架治疗的创伤性更小,术后恢复快,并发症发生率低,但锁定加压钢板短期疗效明显,对于桡骨远端严重粉碎性骨折无法用钢板内固定时,外固定支架是较好的选择。
Objective To observe the clinical effect of external fixator and locking plate internal fixation in the treatment of distal radius C type fractures, in order to provide a reference for the treatment of distal radius C fractures. Methods From January 2015 to January 2017, 90 cases of distal radius C type fractures were selected as the subjects. The enrolled patients were randomly divided into observation group and control group,with 45 cases in each group. The patients in the observation group were treated with external fixator,and the control group was treated with locking plate internal fixation. The operation time, the amount ofblood loss,the time of hospitalization and the time of fracture healing were compared between the two groups.At the same time, the types and incidence of postoperative complications in the two groups were statistically compared, and the safety of the two groups of surgical methods was evaluated. In addition, two groups of patients were followed up for 12 months after discharge. The postoperative palmar tilt, ulnar deviation and radius height were compared in two groups. Gartland-Werly wrist joint scoring system was used to compare the wrist joint recovery function of two groups of patients after operation.Results（1）The postoperative recovery indicators in patients in the observation group included operation time, intraoperative blood loss,hospitalization time and fracture healing time,which were（28.91±8.37） min,（69.35±11.82）mL,（6.21±1.23）d and（47.12 ±11.35）d respectively. The above indicators were significantly lower than those in the control group,which were（54.42±9.85）min,（95.07±17.64）mL,（11.08±2.36）d and（68.30±14.02）d（P〈0.05）.（2）The incidence of postoperative complications in the observation group was 6.67%（3/45）,which was lower than that in the control group. The complication rate was 22.22%（10/45）. The difference between the two groups was statistically significant（P〈0.05）.（3）In the twelfth-month follow up, the imaging measurement of the palmar tilt, ulnar inclination and radial height among patients in the observation group were（10.13 ±1.48）°,（20.11 ±2.09）° and（10.03 ±1.87）mm respectively and those in the control group were（10.67 ±1.59）°,（20.59±2.31）° and（9.86±1.91）mm. There was no significant difference between groups（P〈0.05）.（4）Six and 12 months after the operation, the Gartland-Werly wrist score in the observation group were measured as（6.21 ±1.98） and（2.71 ±0.95） points, which was higher than those in the control group with（4.06±1.54） and（2.23±0.63） points. The difference between the two groups was statistically significant（P〈0.05）. Conclusion External fixation with locking plate fixation in the treatment of distal radial C has a good effect on the healing and recovery of the fracture,with smaller trauma,faster postoperative recovery and low complication rate. But the locking compression plate shows a short-term curative effect. For severe comminuted distal radial fracture,which cannot be fixed with steel plate,external fixation is a better choice.
作者
张国志
陆晓涛
邓永成
ZHANG Guo-zhi;LU Xiao-tao;DENG Yong-cheng(Dept.of Orthopaedics,The 2nd People＇s Hospital of Yunnan Province,Kunming Yunnan 650021,China)
出处
《昆明医科大学学报》
CAS
2018年第10期84-89,共6页
Journal of Kunming Medical University
基金
云南省卫生科技基金资助项目(04W002-3-007-R1)
关键词
桡骨远端C型骨折
外固定支架
锁定钢板内固定
骨折愈合
C type fracture of the distal radius
External fixator
Locking plate internal fixation
Fracturehealing
