手术治疗桡骨远端骨折的预后及影响因素分析  

Fractures of the distal radius treated by internal fixation： a retrospective study of 105 cases

作　　者：姜柏林[1] 陈建海[1] 付中国[1] 张培训[1] 张殿英[1] 姜保国[1] 

机构地区：[1]北京大学人民医院创伤骨科,北京大学交通医学中心,100044

出　　处：《中华创伤骨科杂志》2009年第5期416-420,共5页Chinese Journal of Orthopaedic Trauma

基　　金：国家“十一五”科技支撑计划基金（2007BA104806）

摘　　要：目的探讨手术治疗桡骨远端骨折的预后并分析其影响因素。方法1999年1月至2008年7月手术治疗桡骨远端骨折104例（105侧），使用锁定加压钢板63侧，T形钢板40侧，克氏针1侧，克氏针加外固定架1侧。采用影像学评分、Gartland＆Wedey评分评价疗效，并分析其影响因素。结果所有患者随访3～72个月，平均25个月。根据Batra影像学评分：优60侧，良37侧，可5侧，差3侧，优良率92．4％（97／105）。年龄〈65岁患者的影像学评分优于年龄≥65岁患者（P=0．013）。根据Garland＆Werley评分：优84侧，良20侧，可1侧，优良率99．0％（104／105）。骨折分型为轻型患者的Garland＆Werley评分优于骨折分型严重的患者（P=0．046）。术中复位满意患者的Garland＆Werley结果为优的可能性是欠满意者的3．6倍（P=0．042）。结论切开复位板钉内固定治疗桡骨远端骨折可以取得良好的疗效。年龄是术后影像学评分的影响因素，骨折分型和术中复位情况可以对术后功能评分产生影响。Objective To evaluate the functional and radiological outcomes of distal radius fractures treated with open reduction and internal fixation （ORIF） and to analyze the possible influencing factors. Methods One hundred and five fractures of the distal radius were treated with open reduction and internal fixation. Sixty-three fractures were treated with locking compression plate（LCP）, 40 fractures with AO T-plate, 1 fracture with external fixation, 1 fracture with external fixator arid Kirschner wire. The functional and radiological outcomes were evaluated with Visual Analog Scale（VAS）, Gartland ＆ Werley and Batra scoring systems, and the possible influencing factors were analyzed. Results The mean follow-up time was 25 mouths. By Gartland ＆ Werley scoring, 80. 0% of the patients were excellent, 19.0% good, and 1, 0% fair. According to Batra radiological scoring system, 60 cases（57. 1% ） were excellent, 37 cases （35.2%） good, 5 cases （4.8%） fair, and 3 cases （2.9%） poor. The final radiological scores in patients younger than 65 were better than elder ones （ P = 0. 013）. Patients with a modest type of fracture had a higher Gartland ＆ Werley score than those with a severe one （ P = 0. 046） . Patients who had been reduced sarisfactorily in the operation had a higher Gartland ＆ Werley score than those less satisfactorily （ P = 0. 042）. Conclusions ORIF using plates in the treatment of distal radius fractures will achieve good outcomes. Age may be an influencing factor for radiological scoring, while reduction in the operation and AO types of fractures are the influencing factors for Gartland ＆ Werley scoring.

关 键 词：桡骨 骨折 骨折固定术 治疗结果 

分 类 号：R686[医药卫生—骨科学]