背侧双钢板与外固定支架治疗C型桡骨远端骨折的疗效对比研究  

Comparison of dorsal double-plate versus external fixator in the trealment of AO type C distal radial fractures

作　　者：曾庆敏[1] 卢伟[1] 刘德昌[1] 张新潮[1] 吴靖平[1] 

机构地区：[1]复旦大学附属金山医院骨科,上海201508

出　　处：《中华手外科杂志》2014年第2期127-130,共4页Chinese Journal of Hand Surgery

摘　　要：目的比较背侧双钢板与外固定支架治疗背侧粉碎性C型桡骨远端骨折的临床疗效。方法回顾性分析2009年1月至2012年12月采用背侧双钢板与外固定支架治疗背侧粉碎性c型桡骨远端骨折患者41例。其中背侧双钢板组2，4例，采用背侧切口，按三柱理论，用双钢板分别固定中间柱和桡侧柱。外固定支架组17例，采用闭合复位超腕关节外固定支架固定。结果术后背侧双钢板组随访12～36个月，平均18．2个月，外固定支架组随访10。34个月，平均15．8个月。x线片显示两组骨折全部愈合。背侧双钢板组患者尺偏角、桡骨高度及Gartland-Wetley评分均优于外固定支架组，差异有统计学意义（P〈0．05），而在掌倾角恢复方面差异无统计学意义（P〉0．05）。双钢板组伤口感染1例，腱鞘炎1例，桡神经浅支损伤1例；外固定支架组钉道感染2例，固定松动1例，腕关节僵硬2例。两组在患者满意度上差异无统计学意义（P〉0．05）。结论背侧双钢板对背侧粉碎性C型桡骨远端骨折的疗效优于外固定支架，但双钢板固定手术复杂、费用高、需二次住院手术取出内固定，两组在患者满意度上差异无统计学意义，因此临床上需根据患者具体情况选择合适的治疗方式。Objective To compare the clinical effects of the dorsal double-plate and external fixator in the treatment of the AO type C distal radial dorsal comminuted fractures. Methods Forty-one cases of AO type C distal radial dorsal comminuted fractures that were treated with dorsal double-plate and external fixator from January 2009 to December 2012 were retrospectively analyzed. The dorsal double-plate group consisted of 24 patients. They were treated with dorsal open reduction and double-plate internal fixation of the middle column and radial column according to three-column theory. External fixator group consisted of 17 patients who were managed by closed reduction and cross wrist external fixator. Results Postoperatively patients in the dorsal double-plate group were follow-up for 12 to 36 months, with an average of 18.2 months. External fixator group was follow-up for an average of 15.8 months ranging from 10 to 34 months. X-rays showed fractures in both groups all healed. The ulnar deviation, radial height and Gartland-Werley score were significantly better in the dorsal double-plate group than in the external fixator group （ P 〈 0.05）, while there was no significant difference in the volar tilt （ P 〉 0.05）. As for complications, there was 1 case of wound infection, 1 case of tenosynovitis and 1 case of superficial radial nerve injury in the dorsal double-plate group; 2 cases of pin tract infection, 1 case of fixator loosening and 2 cases of wrist stiffness in the external fixator group. Conclusion Treatment outcomes of dorsal double-plate fixation are better than that of external fixator fation of type C distal radial dorsal comminuted fractures. However it is a more complex surgery, costs more and requires a secondary surgery to remove the hard wares. Patients＇ satisfaction is not much different. The choices of treatment method depend on the patients＇ clinical conditions.

关 键 词：骨折固定术 内 病例对照研究 桡骨远端 双钢板 外固定器 

分 类 号：R687.3[医药卫生—骨科学]