外固定架结合克氏针有限固定与掌侧锁定板治疗桡骨远端粉碎骨折的疗效对比  

Comparison of the cfinical efficacy of external fixator combined with Kirschner wire and volar locking plate in the treatment of comminuted fractures of the distal radius

作　　者：李家德[1] 钟永翔 陈榆[1] 黎沛裕 Li Jiade;Zhong Yongxiang;Chen Yu;Li Peru(Department of Orthopedies, Taizhou Integrated Traditional and Western Medicine Hospital, Zhejiang 317523, China)

机构地区：[1]台州市中西医结合医院骨科,浙江317523

出　　处：《中华手外科杂志》2018年第3期185-188,共4页Chinese Journal of Hand Surgery

摘　　要：目的探讨外固定架结合克氏针有限固定与掌侧锁定板治疗桡骨远端粉碎骨折的临床疗效。方法自2012年3月至2015年12月，采用外固定支架结合克氏针有限固定和掌侧入路锁定板两种方法治疗桡骨远端粉碎骨折患者68例。骨折A0分型：C1型30例，C2型24例，C3型14例。外固定架组34例，钢板固定组34例。比较两组术后3、12个月影像学结果（掌倾角、尺偏角、桡骨高度）及腕关节活动度（背伸、掌屈、桡偏、尺偏、旋前、旋后），采用改良Gartland-Werley（GW）评分评定术后3、12个月的腕关节功能。结果术后随访时间6~24个月，平均12个月。外固定支架组有1例发生第二掌骨骨折，钢板组有1例出现正中神经卡压症状，其余患者均未出现并发症。术后3、12个月钢板组的掌倾角、尺偏角、桡骨高均大于外固定架组，差异有统计学意义（P〈0．05）。术后3个月钢板组腕关节背伸、掌屈、桡偏、尺偏、旋前、旋后活动度均大于外固定架组，差异有统计学意义（P〈0．05）；而术后12个月两组比较差异无统计学意义（P〉0．05）。改良GW评分：术后3个月钢板组小于外固定支架组，差异有统计学意义（t=-3．270，P〈0．05）；而术后12个月两组比较差异无统计学意义（t=-1．393，P〉0．05）。结论对于桡骨远端C型骨折，两种固定方式均能获得较好疗效，钢板组影像学结果优于外固定支架组，近期疗效明显，但远期疗效相当，对于桡骨远端粉碎严重无法使用钢板、伴有骨质疏松或有糖尿病者，外固定支架结合克氏针固定是不错的选择。Objective To investigate the clinical efficacy of external fixator combined with Kirsclmer wire and volar locking plate in the treatment of comminuted distal radius fractures. Methods From March 2012 to December 2015, 68 cases of eomminuted distal radius fractures were treated with external fixator combined with Kirschner wire and volar locking plate. According to AO classification, there were 30 cases of C1 type, 24 cases of C2 type and 14 cases of C3 type. There were 34 cases in external fixator group and 34 cases in plate fixation group. The imaging results （palmar tilt, ulnar inclination and radial height） and wrist motion （dorsal extension, palmar flexion, radial deviation, ulnar deviation, pronation and supination） of the two groups were compared at 3 and 12 months after the operation. And the wrist fimction was evaluated by modified Gartland-Werley （GW） score. Results All the patients were follow-up from 6 to 24 months with an average of 12 months. There was 1 case of second metacarpal fracture in external fixator group and 1 case of median nerve entrapment in plate fixation group. No complications occurred in the rest of the patients. At 3 and 12 months after the operation, the palmar tilt, ulnar inclination and radial height from plate fixation group were greater than those from external fixator group, and the difference was statistically significant （P〈0.05）. At 3 months after the operation, dorsal extension, palmar flexion, radial deviation, ulnar deviation, pronation and supination of wrist motion from plate fixation group were greater than those from external fixator group. The difference was statistically significant （P〈0.05）, but there was no significant difference between the two groups at 12 months after the operation （P〉0.05）. The modified GW score of plate fixation group was smaller than that of external fixator group at 3 months after the operation, and the difference was statistically significant （t=-3.270, P〈0.05）. However, there was no significant differe

关 键 词：桡骨骨折 骨折固定术 内 外固定器 比较研究 

分 类 号：R687.3[医药卫生—骨科学]