3种不同固定方式治疗桡骨远端C型骨折的疗效比较  

A clinical comparison of three kinds of fixation for treatment of type C distal radius fractures

作　　者：王仲锋[1] 王晓[1] 李国军[1] 张淞[1] 刘洋[1] 

机构地区：[1]河南大学淮河医院,河南开封475000

出　　处：《中医正骨》2016年第7期14-19,共6页The Journal of Traditional Chinese Orthopedics and Traumatology

摘　　要：目的：比较T形锁定钢板内固定、T形锁定钢板内固定联合外固定架外固定及万向双柱锁定钢板内固定治疗桡骨远端C型骨折的临床疗效。方法：回顾性分析2008年1月至2015年1月手术治疗的100例桡骨远端C型骨折患者的病例资料,男43例、女57例;年龄20~75岁,中位数46岁,左侧48例,右侧52例。采用T形锁定钢板内固定35例,采用T形锁定钢板内固定联合外固定架外固定33例,采用万向双柱锁定钢板内固定32例。对比3组患者的骨折愈合情况、患肢腕关节活动度（背伸、掌屈、桡偏、尺偏）、患侧手握力、掌倾角、尺偏角、桡骨短缩长度及采用腕关节功能（patient-rated wrist evaluation,PRWE）评分标准评价的腕关节功能。结果：100例患者均获随访,随访时间12~36个月,中位数24个月;骨折均愈合,愈合时间12~22周,中位数16周。术后12个月,3组腕关节活动度（背伸、掌屈、桡偏、尺偏）、患侧手握力（占健侧百分比）、掌倾角、尺偏角、桡骨短缩长度和PRWE评分的组间差异均有统计学意义[（58.3°±5.7°）,（62.9°±6.6°）,（63.6°±7.5°）,F=6.299,P=0.003;（60.3°±6.8°）,（68.1°±6.8°）,（69.2°±7.7°）,F=6.635,P=0.002;（16.3°±1.9°）,（20.3°±2.4°）,（19.8°±2.3°）,F=34.365,P=0.000;（20.8°±2.7°）,（23.4°±4.0°）,（24.4°±2.6°）,F=11.605,P=0.000;（70.4±2.7）%,（84.2±4.2）%,（84.3±4.3）%,F=65.652,P=0.000;（8.2°±1.8°）,（9.9°±2.1°）,（10.0°±1.8°）,F=10.120,P=0.000;（13.7°±2.9°）,（18.6°±3.6°）,（19.8°±2.3°）,F=40.137,P=0.000;（3.2±0.9）mm,（2.4±0.9）mm,（2.6±0.9）mm,F=7.516,P=0.000;（6.3±1.2）分,（8.0±0.9）分,（7.6±0.9）分,F=27.196,P=0.000]。与T形锁定钢板联合外固定支架组和万向双柱锁定钢板组相比,T形锁定钢板组腕关节活动度和患侧手握力较差、掌倾角和尺偏角较小、桡骨短缩程度较大、PRWE评分均较低（P=0.005,P=0.007,P=0.000,P=0.00Objective： To compare the clinical curative effects of T- shape locking plate internal fixation versus T- shape locking plate internal fixation combined with external fixator external fixation versus universal double rods locking plate internal fixation in treatment of type C distal radius fractures. Methods： The medical records of 100 patients with type C distal radius fractures who received surgery from January 2008 to January 2015 were analyzed retrospectively. The patients consisted of 43 males and 57 females,and ranged in age from 20 to 75 years（ Median = 46 yrs）. The fractures located in left radius for 48 patients and right radius for 52 patients. Thirty-five patients were treated with T- shape locking plate internal fixation（ group A）,and 33 patients were treated with T- shape locking plate internal fixation combined with external fixator external fixation（ group B）,while 32 patients were treated with universal double rods locking plate internal fixation（ group C）. The fracture healing,range of motion（ ROM） of wrist（ dorsal expansion,palmar flexion,radial deviation and ulnar deviation）,hand grip strength of affected side,volar tilt angles,radial inclination angles,radial shortening length and wrist function were compared between the 3 groups. The wrist function were evaluated by using patient- rated wrist evaluation（ PRWE） scoring standard. Results：All patients in the 3 groups were followed up for 12- 36 months with a median of 24 months and all fractures healed for 12- 22 weeks with a median of 16 weeks. There was statistical difference in wrist ROM（ dorsal expansion,palmar flexion,radial deviation and ulnar deviation）,hand grip strength of affected side,volar tilt angles,radial inclination angles,radial shortening length and PRWE scores between the 3groups at 12 months after surgery（ 58. 3 ＋ /- 5. 7,62. 9 ＋ /- 6. 6,63. 6 ＋ /- 7. 5 degrees,F = 6. 299,P = 0. 003; 60. 3 ＋ /- 6. 8,68. 1 ＋ /- 6. 8,69. 2 ＋ /- 7. 7 degrees,F = 6. 635,P = 0. 002; 16. 3 ＋ /-

关 键 词：桡骨骨折 桡腕关节 骨折固定术 

分 类 号：R687.3[医药卫生—骨科学]