掌侧锁定接骨板与外固定架固定治疗不稳定桡骨远端关节内骨折的疗效比较  

Comparison of the effect of volar locking plate and external fixator in the treatment of unstable distal radius intra-articular fractures

作　　者：张国富 王振继 冯国英 黄亚男 ZHANG Guo-fu;WANG Zhen-ji;FENG Guo-ying;HUANG Ya-nan(Department of Orthopaedics,Tongzhou Hospital of integrated traditional Chinese and Western Medicine,Beijing 101100,China;不详)

机构地区：[1]北京市通州区中西医结合医院骨科,北京101100 [2]廊坊市第四人民医院手足外科

出　　处：《中国骨与关节损伤杂志》2021年第3期248-251,共4页Chinese Journal of Bone and Joint Injury

摘　　要：目的比较掌侧锁定接骨板与外固定架固定治疗不稳定桡骨远端关节内骨折的临床疗效。方法回顾性分析自2015-01—2018-03诊治的78例不稳定桡骨远端关节内骨折,47例采用掌侧锁定接骨板固定手术治疗(锁定板组),31例采用外固定架手术治疗(外固定组)。比较2组手术时间、并发症情况,以及末次随访时关节塌陷情况、DASH评分、Gartland-Werley评分、握力、屈曲度、背伸度、旋前度、旋后度、桡侧倾斜度、尺侧倾斜度。结果 78例均顺利完成手术,随访时间12~32个月,平均16.2个月。锁定板组手术时间较外固定组长,差异有统计学意义(P<0.05)。2组并发症情况比较差异无统计学意义(P>0.05)。末次随访时2组DASH评分、Gartland-Werley评分、握力、腕关节背伸度、旋后度、桡侧倾斜度以及尺侧倾斜度比较差异无统计学意义(P>0.05);锁定板组在屈曲度、旋前度表现较外固定组更好,关节塌陷数较外固定组少,差异有统计学意义(P<0.05)。结论掌侧锁定接骨板手术治疗不稳定性桡骨远端关节内骨折能更好地恢复腕关节的屈曲和旋前功能,维持关节面平整性,但并不能减少并发症以及获得更好的功能评分;医师应综合考虑骨折分型、关节面塌陷以及患者的需求,选择合适的手术方法。Objective To compare the clinical efficacy of volar locking plate and external fixator in the treatment of unstable intra-articular distal radius fractures.MethodsSeventy eight cases of unstable intra-articular distal radius fractures treated from January 2015 to March 2018 were retrospectively analyzed. Forty-seven cases were treated with volar locking plate fixation(locking plate group), and 31 cases were treated with external fixator(external fixator group). The operation time, complications,joint collapse, DASH score, Gartland Werley score, grip strength, flexion, back extension, pronation, supination, radial inclination and ulnar inclination at the last follow-up were compared between the two groups.ResultsAll 78 cases completed the operation successfully, and the follow-up time was 12-32 months(mean 16.2 months). The operation time of locking plate group was longer than that of external fixator group, and the difference was statistically significant(P<0.05). There was no significant difference in complications between the two groups(P>0.05). At the last follow-up, there was no significant difference in DASH score, Gartland Werley score, grip strength, wrist dorsiflexion, supination, radial inclination and ulnar inclination between the two groups(P>0.05);the flexion and pronation of the locking plate group were better than those of the external fixator group, and the joint collapse of locking plate group was less than that of the external fixator group(P<0.05).ConclusionIn the treatment of unstable distal radius intra-articular fractures, the volar locking bone plate can better restore the flexion and pronation function of the wrist joint, as well as correct and maintain the flatness of the articular surface, however, it can not reduce complications and obtain better functional scores;the surgeon should comprehensively consider the fracture classification, articular surface collapse, bone quality and the needs of the patient, and choose the appropriate surgical method.

关 键 词：不稳定桡骨远端关节内骨折 掌侧锁定接骨板 外固定架 Henry入路 

分 类 号：R687.3[医药卫生—骨科学]