不同固定方法治疗桡骨远端骨折的疗效比较

目的探讨不同分型的桡骨远端骨折的有效治疗方法。方法分析102例桡骨远端骨折患者的治疗方法，根据AO分型分为A、B、C共3种类型，分别采用手法复位石膏外固定、外固定支架固定及切开复位“T”形锁定加压钢板（LCP）内固定3种固定方法，比较3种固定方法的骨折复位评分及功能评分优良率。结果102例患者术后均获随访，随访时间6～20个月，平均14．6个月。石膏固定组、外固定支架组与LCP组在A型骨折治疗中无显著差异（P〉0．05）；B型骨折治疗方面，LCP组明显优于其他2组（P〈005），而石膏固定组和外固定支架组经比较差异无统计学意义（P〉O．05）；在复位评分和功能评分方面，LCP组优良率明显优于其他2组，且外固定支架组显著优于石膏固定组（P〈0．05）。结论A型、B型稳定骨折首选手法为复位石膏外固定，不仅能获得良好疗效，还减轻了患者经济负担；粉碎性骨折（C3型骨折）、开放性骨折等可选择外固定支架技术，或者配合克氏针、锁定加压钢板内固定等技术即可取得满意效果；不稳定骨折、累及关节面骨折（B型、C型骨折）首选锁定加压钢板内固定。

Effects of different fixations in the treatment of distal radius fracture

Objective To evaluate the clinical effects after treatment on distal radius frac- ture with different fixations. Method There were 102 cases with the distal radius fracture, which were divided into types of A, B, and C, according to the AO classification. 42 cases out of 102 cas- e-s were treated with external plaster splint fixation, 40 out of 102 cases with operation and internal T model locking compression plate fixation, and the rest 20 out of 102 cases with external fixator. Effects were evaluated by replacement and function after treatment, and percentage of excellence was compared with three different fixations. Results All of the 102 cases were followed up for 6 to 20 months, with a mean period of 14.6 months. The excellence rate of diaplasis was not signifi- cantly different in type A by comparing three different fixations （P 〉0.05）, and LCP internal fix- ation was better than the other two groups in type B （P 〈 0.05）. There was not significant differ- ence about the excellence rate of function with external plaster splint fixation and external fixator （P 〉0.05）. The excellence rate of function and reduction with type ＂T＂ LCP internal fixation were better than with piaster splint and external fixator in type C （P 〈 0.05）. Conclusion The exter- nal plaster splint fixation is the first choice for type A and type B fractures, and it can not only ob- tain good therapeutic effect, but reduce the financial burden of patients as well. External fixator technique, combined with Kirschner wire and locking compression place can achieve satisfactory ef- fect in the treatment of comminuted fractures （C3 type） and open fractures. Locking compression plate fixation is preferred for unstable fractures and fractures involving articular surface.