不稳定桡骨远端骨折的手术治疗

目的 比较钢板和外固定架固定治疗不稳定桡骨远端骨折的临床效果.方法 回顾性分析2004年6月至2008年6月,获得随访的AO/ASIF分型为A3型及B2型以上的各类不稳定桡骨远端骨折患者64例,分别采用T形钢板固定治疗30例、外固定架固定治疗34例.放射学治疗结果按Batra和Gupta评分标准进行评分,功能恢复以腕关节疼痛及功能障碍程度作为评价指标,比较两组的治疗效果.方果 钢板固定组骨折愈合时间为6～12周,平均7.4周.Batra和Gupta评分70分以下2例,70分以上2例,80分以上26例;优良率为86.7%.其中5例(5/30例)患者有腕关节轻度疼痛,3例(3/30例)有至少一个方向的活动范围达不到腕关节活动范围评分的最低功能要求.外固定架组的骨折愈合时间为6～12周,平均7.1周.按Batra和Gupta评分70分以下3例,70分以上3例,80分以上28例;优良率为82.4%.其中5例(5/34例)患者有腕关节轻度疼痛,6例(6/34例)有至少一个方向的活动范围达不到腕关节活动范围评分的最低功能要求.方论 采用钢板及外固定架治疗不稳定桡骨远端骨折均可取得良好的治疗结果,具体可根据患者的功能需求、年龄及经济状况灵活选择固定方式.

Surgical treatment of unstable distal radius fractures

Objective To compare the treatment outcomes of plate fixation arid external fixation of unstable distal radius fractures.Methods Retrospective analysis of 64 cases of unstable distal radius fractures,AO/ASIF type A3 and type B2,treated from June 2004 to June 2008 was carried out.T-shaped plate fixation was used in 30 cases while external fixation was used in 34.Radiological results were assessed using Batra and Gupta scoring system.Functional recovery was judged by wrist pain and functional deficit.Results were comparea between the two treatment groups.Results Fracture healing time of the plate fixation group was 6 to12 weeks(average 7.4 weeks).Batra and Gupta score was below 70 for 2 cases,above 70 for 2 cases,and above 80 for 26 cases.The excellent and good rate was 86.7%.Five patients in this group(5/30)had mild wrist pain,while three patients(3/30)could not achieve the minimal wrist function requirements of range of motion in at least one direction of movement.Fracture healing time of the external fixation group was 6 to 12weeks(average 7.1 weeks).Batra and Cupta score was below 70 for 3 cases,above 70 for 3 cases,and above80 for 28 cases.The excellent and good rate was 82.4%.Five patients(5/34)had mild wrist pain and six patients(6/34)could not achieve the minimal wrist function requirements of range of motion in at least one direction of movement.The two groups showed no significant differences in radiology assessment,wrist pain and wrist dysfunction.Conclusion Both plate fixation and external fixation of unstable distal radius fractures can lead to good treatment outcomes.Patients'functional requirement,age and financial status should be taken into consideration while choosing one of these procedures.