掌侧“T”形钢板和外固定支架治疗尺桡骨远端复杂骨折的疗效分析  

Comparative study of two operation methods on complicated fractures of the distal radius and ulna

作　　者：张传毅[1] 马毅[1] 王章富[1] 洪正华[1] 陈海啸[1] 

机构地区：[1]台州医院骨科,浙江临海317000

出　　处：《中国骨伤》2010年第8期575-577,共3页China Journal of Orthopaedics and Traumatology

摘　　要：目的:比较掌侧"T"形钢板和外固定支架治疗尺桡骨远端复杂骨折的疗效,探讨治疗该型骨折的有效手术方法。方法:2005年7月至2007年7月,分别采用切开复位桡骨掌侧"T"形钢板内固定、外固定支架结合克氏针有限内固定两种手术方法治疗48例尺桡骨远端复杂骨折。其中内固定组男21例,女9例,年龄22～52岁,平均(38.4±1.5)岁;外固定支架组男10例,女8例,年龄25～56岁,平均(40.5±2.3)岁。术后复查X线片,测量桡骨高度和掌倾角、尺偏角,比较两组患者的差异。分别于术后6、12个月采用改良Gartland-Werley(GW)评分方法评定两组患者的腕关节功能。结果:所有患者均得到随访,时间12～18个月,平均14.2个月。术后测量影像学参数,桡骨高度:内固定组平均(8.82±0.55)mm,外固定支架组平均(8.25±0.36)mm;掌倾角:内固定组平均(9.23±0.86)°,外固定支架组平均(8.56±0.72)°;尺偏角:内固定组平均(19.66±1.38)°,外固定支架组平均(18.82±1.42)°。内固定组均优于外固定支架组,但两者差异无统计学意义(P>0.05)。6个月时内固定组中优16例,良7例,可5例,差2例;外固定支架组优4例,良2例,可8例,差4例;内固定组GW评分低于外固定支架组,两者差异有统计学意义(P<0.05)。12个月时内固定组优17例,良7例,可5例,差1例;外固定组优5例,良9例,可2例,差2例;内固定组GW评分也低于外固定支架组,但两者差异无统计学意义(P>0.05)。结论:切开复位掌侧钢板内固定相对于外固定支架的方法,功能恢复快,并发症少,短期疗效前者明显优于后者。但是从远期疗效看,两种方法治疗后腕关节功能无明显差异。Objective：To compare the differences between external fixator and volar T shaped plate in the treatment of complicated fractures of the distal radius and ulna,and evaluate the appropriate operation method for the fractures.Methods： From July 2005 to July 2007,forty eight cases of complicated fractures of the distal radius and ulna were treated with operation.There were 21 males and 9 females in the internal fixator group,ranged from 22 to 52 years old（with an average of 38.4±1.5 years）.There were 10 mals and 8 femals in the external fixator group,ranged from 25 to 56 years old（with an average of 40.5± 2.3 years）.The X ray films were measured to acquire radial length,palmar tilt and radial inclination after operations.The func-tional evaluation were scored with a modified Gartland and Werley＇s（GW） scoring system at 6 and 12 months after operation.Results：The patients were followed up for 12 to 18 months with an average of 14.2 months.The radial length was（8.82±0.55） mm,palmar tilt（9.23±0.86）°,radial inclination（19.66±1.38）° in the internal fixator group,while those were（8.25±0.36） mm,（8.56±0.72）°,（18.82±1.42）° in the external fixator group.The film parameter of internal fixator group was better than the ex-ternal fixator group,but with no statistical significance（P〉0.05）.In the internal fixator group,16 cases obtained excellent,7 good,5 fair,2 poor,while in the external fixator group,4 cases obtained excellent,2 good,8 fair,4 poor in 6 months.The GW scores of internal fixator group were lower than that of the external fixator group（P〉0.05）.At 12 months after surgery,in the in-ternal fixator group,17 cases obtained excellent,7 good,5 fair,1 poor;while in the external fixator group,5 cases obtained ex-cellent,9 good,2 fair,2 poor.The GW score was similar between the two groups（P〉0.05）.Conclusion：The volar T shaped plate fixation may offer effective stability,the short term outcome is better than the external fixator group,and there are rela-

关 键 词：桡骨骨折 外固定器 骨折固定术 内 临床对照试验 

分 类 号：R683.41[医药卫生—骨科学]