两种方法治疗老年桡骨远端C型骨折的疗效比较  

Comparison effect of two methods for treatment of type C distal radius fractures in the elderly

作　　者：王洪凯 桂甜 毛鹏 陈勇 陈懿 戴厚杰 WANG Hong-kai;GUI Tian;MAO Peng;CHEN Yong;CHEN Yi;DAI Hou-jie(Dept of Orthopaedics,the Second Affiliated Hospital of Guilin Medical University,Guilin,Guangxi 541199,China;Guangxi Medical Health Key Cultivation Discipline,Guilin,Guangxi 541199,China)

机构地区：[1]桂林医学院第二附属医院骨科,广西桂林541199 [2]广西医疗卫生重点培育学科,广西桂林541199

出　　处：《临床骨科杂志》2024年第6期824-828,共5页Journal of Clinical Orthopaedics

基　　金：国家自然科学基金(编号:81960172);广西自然科学基金(编号:2020GXNSFAA238014);广西卫健委自筹经费项目(编号:Z20210570)。

摘　　要：目的比较掌侧万向锁定钢板内固定和手法复位小夹板外固定治疗老年桡骨远端C型骨折的疗效。方法根据治疗方式不同将72例老年桡骨远端C型骨折患者分为内固定组(36例,采用掌侧万向锁定钢板内固定治疗)和外固定组(36例,采用手法复位小夹板外固定治疗)。比较两组手术情况、影像学指标、骨折愈合时间、腕关节活动度以及并发症发生率,采用腕关节Cooney评分系统评价功能恢复情况。结果患者均获得随访,时间6~12个月。出血量、住院费用、住院时间内固定组均多(长)于外固定组(P<0.01)。掌倾角、尺偏角两组治疗后均较治疗前改善(P<0.01),治疗后内固定组均优于外固定组(P<0.01)。骨折愈合时间内固定组短于外固定组(P<0.05)。术后并发症发生率两组比较差异无统计学意义(P>0.05)。术后6个月腕关节掌屈、背伸活动度以及腕关节Cooney评分内固定组均优于外固定组(P<0.05)。结论掌侧万向锁定钢板内固定和手法复位小夹板外固定均为治疗老年桡骨远端C型骨折的有效方法,虽然掌侧万向锁定钢板内固定创伤较大、住院时间较长且费用较高,但更有利于骨折的愈合和腕关节的功能恢复。Objective To compare the efficacy of palmar universal locking plate internal fixation and manual reduction small splint external fixation on the distal radius type C fracture of the elderly patients.Methods According to different treatment methods,72 elderly patients with distal radius type C fractures were divided into internal fixation group(36 cases were treated with palmar universal locking plate internal fixation)and external fixation group(36 cases were treated with manual reduction small splint external fixation).Operation situation,imaging indexes,fracture healing time,wrist activity range and complication incidence rate were compared between the two groups,and functional recovery was evaluated by wrist Cooney scoring system.Results All patients were followed up for 6~12 months.The volume of blood loss,hospital cost and hospital stay in the internal fixation group were more(longer)than those in the external fixation group(P<0.01).Palmar inclination angle and ulnar deviation angle:They were improved after treatment compared with before treatment(P<0.01),and internal fixation group was better than external fixation group after treatment(P<0.01).Fracture healing time was shorter in internal fixation group than that in external fixation group(P<0.05).The complication incidence rate had no statistical significance between two groups(P>0.05).At 6 months postoperation,the palmar flexion,dorsiflexion range and Cooney score of the wrist joint in the internal fixation group were better than those in the external fixation group(P<0.05).Conclusions Both palmar universal locking plate internal fixation and manual reduction small splint external fixation are effective methods for the treatment of distal radius type C fracture in elderly patients.Although palmar universal locking plate internal fixation has greater trauma,longer hospital stay and higher cost,it is more beneficial to fracture healing and wrist functional recovery.

关 键 词：万向锁定钢板 外固定 桡骨远端骨折 老年人 

分 类 号：R683.41[医药卫生—骨科学] R687.3[医药卫生—外科学]