尺桡骨中段双骨折四种内固定方法的临床比较研究  

Clinical comparison and research of four methods of treatment to middle-part radius and ulna fracture

作　　者：张晓峰[1] 李晓林[2] 沈国平[1] 罗轶[1] 

机构地区：[1]上海市第六人民医院金山分院骨科 [2]上海市第六人民医院骨科

出　　处：《中华临床医师杂志（电子版）》2011年第7期1973-1979,共7页Chinese Journal of Clinicians(Electronic Edition)

基　　金：上海市卫生局青年科研项目(2008Y062)

摘　　要：目的通过前瞻性研究,比较尺桡骨中段双骨折四种不同内固定治疗方法的特点和临床疗效,筛选最佳方法。方法 2004年9月至2008年3月采用尺桡骨髓内钉及加压钢板四种不同组合治疗尺桡骨中段双骨折87例,所有病例分四组:尺桡骨双钢板(A组),尺桡骨双髓内钉(B组),尺骨钢板加桡骨髓内钉(C组)和尺骨髓内钉加桡骨钢板(D组)。其中A组21例,B组22例,C组21例,D组23例。分析比较手术时间、伤口大小、骨膜剥离程度、术后并发症情况,术后每月摄X线片观察骨折愈合情况并根据Anderson评分标准评估功能恢复情况。结果 87例患者全部获得了随访。随访时间为12～26个月,平均23.4个月。在手术创伤评定中,B组、C组、D组较A组创伤小。并发症发生率D组小于其他三组。87例中84例均获得骨折愈合,3例骨不连。Anderson功能评分:A组:优11例,良3例,可5例,失败2例。B组:优11例,良5例,可5例,失败1例。C组:优14例,良3例,可4例。D组:优20例,良2例,可1例。D组骨折愈合率及功能评分明显高于A组、B组、C组(P<0.05)。结论尺桡骨中段双骨折4种内固定方法治疗都能获得较高的骨折愈合率和功能评分,但尺骨髓内钉加桡骨钢板组手术操作简便,创伤小,骨折愈合率高,并发症少,功能恢复好,在生物力学和生物学固定上达到了良好的组合,是一种比较适合的治疗方法。Objective A prospective study to compare the effect of using four methods of treatment to middle-part radius and ulna fracture,in order to select the best clinical pathway.Methods We have treated 87 cases of mid-radius and ulna fracture cases from September 2004 to March 2008.These patients were divided into four groups:Double-plate fixation group(A group),Double-intramedullary nail fixation group(B group),ulnar plate and radial intramedullary nail group(C group),ulnar intramedullary nailing and radial plate group(D group),A group 21 cases,B group 22 cases,C group 21 cases,D group 23 cases.we analyze and compare its operation time,wound size and degree of periosteal stripping,postoperative complications,observe fracture healing by X-ray films per month,assess functional recovery according to Anderson marking and statistical analysis.Results All 87 patients received follow-up,from 12 months to 26 months,average:23.4 months.In evaluation of the surgical trauma,B,C,D group is a less degree than group A.Complications:D group incidence rate is less than the other three groups.In 87 cases of fracture,84 patients were healed,3 cases of nonunion.Anderson scores:A group:excellent in 11 cases,better in 3 case,good in 5 cases and failed in 2 cases,B group:excellent in 11 cases,better in 5 cases,good in 5 cases,1 case of failure (nonunion).C:excellent in 14 cases,better in 3 cases,good in 4 cases.D group were excellent in 20 cases,better in 2 cases.good in 1 cases.D group healing rate and function scores were significantly higher than the A group,B group,C group (P<0.05).Conclusions Four methods of treatment to middle-part radius and ulna fracture were access to a higher rate of fracture healing and functional score.But ulnar intramedullary nailing and radial plate group was recommended as the preferred method because of the operation was simple,fewer trauma and complications,higher fracture healing rate and functional recovery,achieve the best combination in the biomechanical and biological fixation.So it is recommended as

关 键 词：尺骨骨折 桡骨骨折 内固定器 治疗 

分 类 号：R687.3[医药卫生—骨科学]