桡骨远端骨折内固定与外固定的比较  

Internal fixation with volar locking plate versus external fixator combined with percutaneous Kirshner wire for unstable distal radius fractures

作　　者：马成才[1] 张琪琪 丁超 张伟[1] MA Cheng-cai;ZHANG Qi-qi;DING Chao;ZHANG Wei(Department of Joint Surgery,People's Hospital of Bozhou City,Bozhou 236a800,China)

机构地区：[1]亳州市人民医院关节外科,安徽亳州236800

出　　处：《中国矫形外科杂志》2023年第5期391-395,共5页Orthopedic Journal of China

摘　　要：[目的]比较掌侧锁定钢板(volar locking plate,VLP)与外固定架联合经皮克氏针固定不稳定性桡骨远端骨折(unstable distal radius fractures,UDRF)的临床疗效。[方法]回顾性分析2018年1月—2020年1月本院手术收治的73例UDRF患者的临床资料。依据术前医患沟通结果,41例采用VLP内固定(内固定组),32例采用外固定架联合经皮克氏针固定(外固定组)。比较两组围手术期、随访期及影像学资料。[结果]两组均顺利完成手术,虽然内固定组手术时间显著长于外固定组,但术中透视次数、早期VAS评分均显著优于外固定组(P<0.05)。术后并发症总发生率内固定组为7.3%,外固定组为25.0%,差异有统计学意义(P<0.05)。平均随访(15.3±2.1)个月,内固定组恢复完全负重活动时间显著早于外固定组(P<0.05)。术后内固定组Cooney评分、腕掌屈-背伸ROM、腕尺偏-桡偏ROM、前臂旋前-旋后ROM均优于外固定组(P<0.05)。影像方面,术后即刻和末次随访时,内固定组的PT、RI、RL和关节面对合分级均显著优于外固定组(P<0.05)。影像显示内固定组骨折愈合时间显著早于外固定组(P<0.05)。[结论]与外固定架联合克氏针外固定相比,VLP内固定早期不良反应轻,功能恢复好,更有利于骨折愈合。[Objective]To compare the clinical outcomes of internal fixation with volar locking plate(VLP)versus external fixator combined with percutaneous Kirshner wire for unstable distal radius fractures(UDRF).[Methods]A retrospective study was performed on 73patients who underwent surgical treatment for UDRF in our hospital from January 2018 to January 2020.According to the results of preoperative doctor-patient communication,41 patients received VLP internal fixation(the IF group),while the remaining 32 patients were treated with external fixator combined with percutaneous Kirshner wire(the EF group).The perioperative,follow-up and imaging data were compared between the two groups.[Results]All the patients in both groups had operation performed smoothly.Although the IF group consumed significantly longer operation time than the EF group(P<0.05),the former proved significantly superior to the latter in terms of times of intraoperative fluoroscopy and VAS scores in the early stage(P<0.05).The total incidence of postoperative complications was 7.3%in the IF group,whereas 25.0%in the EF group,which was statistically significant(P<0.05).All patients in both groups were followed up for(15.3±2.1)months on an average,and the IF group returned to full weight-bearing activity significantly earlier than the EF group(P<0.05).In addition,the IF group proved considerably superior to the EF group in terms of Cooney score,flexion-dorsiflexion range of motion(ROM),ulnar-radial deviation ROM,and forearm pronation/supination ROM postoperatively(P<0.05).Radiographically,the IF group proved significantly superior to the EF group in terms of palmar tilt(PT),radial inclination(RI),radial length(RL),and joint congruence grade immediately after surgery and at last follow-up(P<0.05),moreover,the former got fracture healing on images significantly earlier than the latter(P<0.05).[Conclusion]Compared with external fixator combined with Kirschner wire,the VLP internal fixation has fewer early adverse reactions,better functional recovery,and is mo

关 键 词：不稳定性桡骨远端骨折 内固定 掌侧锁定钢板 外固定架 经皮克氏针 

分 类 号：R683.41[医药卫生—骨科学]