掌侧钢板与克氏针辅助外固定架策略在桡骨远端粉碎骨折中应用的近期与远期效果  

The short-term and long-term effects of the volar plate and Kirschner wire-assisted external fixation strategy in the treatment of comminut-ed fractures of the distal radius

作　　者：周贵龙 袁宝明 ZHOU Guilong;YUAN Baoming(Beijing Chaoyang Emergency Rescue Center,Beijing 100023,China)

机构地区：[1]北京朝阳急诊抢救中心,北京100023

出　　处：《中国急救复苏与灾害医学杂志》2021年第12期1410-1414,共5页China Journal of Emergency Resuscitation and Disaster Medicine

摘　　要：目的探讨掌侧钢板与克氏针辅助外固定架策略在桡骨远端粉碎骨折中应用的近期与远期效果。方法回顾性选取2017年2月-2019年10月北京朝阳急诊抢救中心收治的55例行克氏针辅助外固定架策略(外固定组)及55例行掌侧钢板内固定(内固定组)治疗桡骨远端粉碎骨折患者,比较两组手术相关情况、围手术期创伤指标[白介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)、前列腺素E2(PGE2)]、近期与远期效果、影像学指标、核因子kappa B受体活化因子配体(receptor activator of nuclear factor kappa B ligand,RANKL)、骨保护素(osteoprote⁃gerin,OPG)、并发症。结果外固定组术后引流量低于内固定组,手术时间、住院时间短于内固定组(P<0.05);组间骨折愈合时间、并发症总发生率比较,差异无统计学意义(P>0.05);两组术后1 d、3 d IL-6、TNF-α、PGE2均高于术前,术后5 d IL-6、TNF-α、PGE2均降低(P<0.05);外固定组术后1、3 d IL-6、TNF-α、PGE2低于内固定组(P<0.05),但术后5 d两组IL-6、TNF-α、PGE2比较,差异无统计学意义(P>0.05);内固定组术后3个月优良率高于外固定组(P<0.05);组间术后1年优良率比较,差异无统计学意义(P>0.05);内固定组术后3个月、1年掌倾角、尺偏角、桡骨高高于外固定组(P<0.05);组间术后3个月、1年RANKL、OPG比较,差异无统计学意义(P>0.05)。结论①与掌侧钢板内固定对比,克氏针辅助外固定架策略治疗桡骨远端粉碎骨折可有效缩短手术时间及住院时间,降低术后引流量,减轻手术创伤。②与克氏针辅助外固定架策略对比,掌侧钢板内固定治疗桡骨远端粉碎骨折,可有效提高早期腕关节恢复效果,更好地恢复桡骨远端解剖结构。③两种固定方式在骨折愈合时间、远期腕关节恢复效果、并发症及对术后骨代谢指标的影响方面一致。Objective To investigate the short-term and long-term effects of the volar plate and Kirschner wire-assist⁃ed external fixation strategy in the treatment of comminuted fractures of the distal radius.Methods From February 2017 to October 2019,55 cases of Kirschner wire-assisted external fixation strategy(external fixation group)and 55 cases of volar plate internal fixation(internal fixation group)in our hospital were retrospectively selected for the treat⁃ment of comminuted fractures of the distal radius.The operation-related conditions and perioperative trauma indexes[interleukin-6(IL-6),tumor necrosis factor-α(TNF-α),prostaglandin E2(PGE2)],short-term and long-term effects,imaging indicators,receptor activator of nuclear factor kappa B ligand(RANKL),osteoprotegerin(OPG),and complica⁃tions were compared between the two groups.Results The postoperative drainage volume of the external fixation group was lower than that of the internal fixation group,and the operation time and hospital stay were shorter than those of the internal fixation group(P<0.05).There was no statistically significant difference in fracture healing time and total inci⁃dence of complications between the groups(P>0.05).The levels of IL-6,TNF-αand PGE2 at 1 and 3 days after oper⁃ation were higher than those before the operation,and the levels of IL-6,TNF-α,and PGE2 at 5 days after operation were lower(P<0.05).IL-6,TNF-αand PGE2 in the external fixation group were lower than those in the internal fixa⁃tion group at 1 and 3 days after operation(P<0.05).However,there was no significant difference in IL-6,TNF-α,and PGE2 between the two groups at 5 days after operation(P>0.05).The excellent and good rate of the internal fixation group at 3 months after operation was higher than that of the external fixation group(P<0.05).There was no statistically significant difference in the excellent and good rate of 1 year after operation between the groups(P>0.05).The palm inclination,ulnar deflection,and radius height in the internal fixation g

关 键 词：掌侧钢板 克氏针 外固定架 桡骨远端粉碎骨折 影像学指标 核因子kappaB受体活化因子配体 骨保护素 

分 类 号：R274[医药卫生—中医骨伤科学]