外固定支架结合闭合复位有限内固定微创治疗桡骨远端AOC3型骨折的比较研究

目的比较闭合复位有限内固定结合外固定支架与单纯石膏外固定治疗桡骨远端AO C3型骨折的临床疗效。方法随访2005年6月～2010年10月36例桡骨远端AO C3型骨折,其中18例予以单纯石膏固定（石膏组）,18例采用外固定支架结合闭合复位有限内固定（支架组）。随访至术后24周,比较两组患侧临床功能（改良Gartland-Werley功能评分）及X线表现（改良Lidstrom-Radiographic评分系统）。结果所有患者均骨性愈合,无明显感染等严重并发症。术后24周,临床疗效（改良Gartland-Werley功能评分）：支架组腕关节屈（45.06±3.04）°,伸（52.83±2.94）°,桡偏（22.83±2.33）°,尺偏（36.33±5.29）°,旋前（51.67±4.16）°,旋后（44.89±4.13）°;石膏组屈（41.56±3.01）°,伸（49.56±3.58）°,桡偏（20.61±2.17）°,尺偏（31.22±5.35）°,旋前（46.33±4.12）°,旋后（41.33±2.93）°。X线表现（改良Lidstrom-Radiographic评分系统）：支架组桡骨高度（9.11±1.23）mm,掌倾角（16.00±2.40）°,尺偏角（16.39±1.79）°,关节面台阶（1.11±0.76）mm;石膏组桡骨高度（7.61±1.65）mm,掌倾角（13.44±2.48）°,尺偏角（12.67±3.83）°,关节面台阶（2.22±0.94）mm。各项指标支架组均显著优于石膏组（P〈0.01）。结论对于桡骨远端AO C3型粉碎性骨折,采用外固定支架结合闭合复位有限内固定是一种微创有效的方法,但需要注意桡神经浅支损伤等并发症。

External Fixation Combined with Closed Reduction and Percutaneous Fixation vs.Cast for AO Type C3 Fractures of the Distal Radius

Objective To compare the advantages and disadvantages of closed reduction and percutaneous fixation combined with external fixation and cast for AO type C3 fractures of the distal radius. Methods Since June 2005 to October 2010, totally 36 patients with AO type C3 fractures of the distal radius received treatment with cast （cast group, n = 18） , or external fixation combined with closed reduction and pereutaneous fixation （ EF group, n = 18） in our hospital. We followed up the patients for 24 weeks after the treatments, and then compared the modified Gartland-Werley and modified Lidstrom-Radiographic scores between the two groups. Results All the patients achieved bony union after the treatments. No patient developed infection or other severe complications. At 24 weeks after the treatments, the modified Gartland-Werley scoring showed that, in the EF group, the wrist flexion ROM was （45.06 ± 3.04）°, extension ROM （52.83 ± 2.94）°, radial deviation ROM （22. 83 ±2. 33）°, ulnar deviation ROM （36. 33 ±5.29）°, pronation ROM （51.67±4.16）°, and supination ROM （44.89 ±4. 13）°, while in the cast group, flexion ROM was （41.56 ± 3.01）°, extension ROM （49.56 ±3.58）°, radial deviation ROM （20.61 ±2. 17）°, ulnar deviation ROM （31.22 ±5.35）°, pronation ROM （46.33 ± 4. 12）°, and supination ROM （41.33 ± 2.93）°. Modified Lidstrom-Radiographic Scoring System showed that, in the EF group, the radius height was （9. 11 ± 1.23 ） mm, radial inclination （ 16.00 ± 2.40 ） °, ulnar deviation （ 16.39 ± 1.79）°, and mean articular step-off （1.11 ±0.76） mm, while in the cast group, the radius height was （7.61 ± 1.65） mm, radial inclination （ 13.44 ± 2.48） °, ulnar deviation （ 12.67 ± 3.83 ） °, and mean articular step-off （2.22 ± 0.94） mm. All the parameters above showed that external fixation combined with closed reduction and percutaneous fixation was superior to cast （All P 〈 0.01 ）. Conclusions External fixation combined with closed reduction and percutaneous fixation is effective and minimally invasive for AO type C3 fractures of the distal radius. Attention shall be paid to avoid complications such as injury to the superficial branch of radial nerve.