小夹板和锁定钢板治疗老年人桡骨远端关节内骨折的比较  

Plintlet versus locking plate for treating intra-articular distal radius fracture in the elderly

作　　者：魏立友[1] 李忠民[1] 张文芳 张宏伟[1] 

机构地区：[1]河北唐山市第二医院骨科,063000

出　　处：《中国矫形外科杂志》2017年第24期2238-2243,共6页Orthopedic Journal of China

摘　　要：[目的]比较闭合复位小夹板外固定和切开复位锁定钢板内固定治疗老年桡骨远端关节内骨折的临床疗效。[方法]2013年1月~2014年12月,将66例桡骨远端关节内骨折的患者随机分为手法复位小夹板外固定治疗(保守组)和切开复位锁定钢板内固定(手术组)各33例。分别于治疗前、复位后、骨折愈合时,记录患者骨折复位状态(掌倾角、尺偏角、桡骨高)。记录患者骨折愈合时间。于骨折愈合时,记录腕关节活动度(屈伸活动度、桡尺偏活动度、旋前后活动度)、Mayo腕关节评分。[结果]治疗前,两组患者一般情况及骨折状况,差异无统计学意义。复位后、骨折愈合时,手术组患者掌倾角、尺偏角、桡骨高好于保守组,差异有统计学意义(P<0.05)。骨折愈合时,手术组的掌倾角、尺偏角、桡骨高与复位后比较,差异无统计学意义(P>0.05);骨折愈合时,保守组的掌倾角、尺偏角、桡骨高与复位后比较,差异有统计学意义(P<0.05)。保守组骨折愈合时间短于手术组,差异有统计学意义(P<0.05)。骨折愈合时,两组患者腕关节活动度、Mayo腕关节评分,差异无统计学意义(P>0.05)。[结论]手法复位小夹板外固定及切开复位锁定钢板内固定均可有效治疗老年桡骨远端关节内骨折。保守治疗存在骨折复位丢失的情况;保守治疗的患者骨折愈合时间相对短;采用手术治疗可获得良好的骨折复位;保守和手术的中远期腕关节功能无差别。[Objective] To compare the outcome of closed reduction plus plintlet external fixation and open reduction plus locking plate internal fixation for treatment of intra-articular distal radius fractures in the elderly. [Methods] From January 2013 to December 2014, 66 elderly patients with distal radius fracture were treated with closed reduction plus plintlet external fixation （the conservative group） , or open reduction plus locking plate internal fixation （ the surgical group） , with 33 cases in each group. At time points before, after reduction and of fracture healing, the palmar tilt, ulnar deviation and radial length were radiographically measured. After fracture healing, wrist range of motion, including flexion-extension, radial-ulnar and prona- tion-supination motion, and Mayo wrist score were evaluated. [Results] Before fracture reduction, there were no statistically sig- nificant differences between the two groups in term of the palmar tilt, ulnar deviation and radial length （P〉0.05） . However, the aforesaid parameters in the conservative group were statistically inferior to the surgical group after fracture reduction and bone healing （P〈0.05）. Compared the measurements after reduction with those after bone healing, the palmar tilt, ulnar deviation and radial length statistically lost in the conservative group （P〈0.05） , whereas no significant variation happened in any of them in the surgical group （P〉0.05） . In addition, fracture healing time in the conservative group was statistically less than the surgical group （P〈0.05） , while no significant differences were noted in ROM and Mayo wrist score between the two groups after bone healing （P〉0.05）. [Conclusion] Both closed reduction plus plintlet external fixation and open reduction with locking plate inter- nal fixation can effectively treat intra-articular distal radius fractures in the elderly with similar mid-term clinical outcomes. Bycontrast, the former has advantage of shortened bone healing time, while disa

关 键 词：骨远端关节内骨折 老年人 小夹板 锁定钢板 

分 类 号：R687.3[医药卫生—骨科学]