闭合复位外固定架固定及切开复位钢板螺丝钉内固定治疗桡骨远端不稳定骨折优劣势比较

目的：分析闭合复位外固定架固定及切开复位钢板螺丝内固定在治疗桡骨远端不稳定性骨折中的优劣势。方法选取2012年1月至2015年1月于博乐市博州人民医院就诊的桡骨远端不稳定性骨折患者108例，按随机数表法分为外、内固定组，每组各54例，分别给予闭合复位外固定架固定及闭合复位钢板螺钉内固定治疗，比较两组患者的手术情况及术后近、中期疗效。结果外固定组患者的平均手术时间、术中出血量、住院时间和骨折愈合时间分别为(30.7±5.4) min、(55.1±8.1) mL、(7.6±2.0) d和(82.8±9.5) d，均明显少于内固定组的(70.3±6.6) min、(80.2±9.3) mL、(12.5±2.7) d、(114.5±12.9) d，差异均有统计学意义(P<0.05)。同时术后3个月外固定组患肢活动时VAS评分(4.2±0.8)分显著高于内固定组的(3.1±0.9)分，差异有统计学意义(P<0.05)。术后3个月内固定组掌倾角、尺偏角、关节面台阶三项指标分别为(12.8±1.5)°、(24.1±1.8)°、(2.2±0.4) mm，与外固定组(9.3±2.0)°、(21.2±2.0)°、(3.0±0.5) mm]差异均具有统计学意义(P<0.05)，而术后1年内固定组上述指标(13.5±1.6)°、(24.9±2.3)°、(0.8±0.4) mm也与外固定组(11.2±2.1)°，(22.7±2.5)°，(1.4±0.6) mm]差异有统计学意义(P<0.05)。术后3个月内固定组主动屈伸、桡尺偏、旋前旋后活动度及手握、捏力与健侧百分比(77.7±5.5)%、(68.4±4.9)%、(80.6±5.0)%、(73.3±5.4)%、(79.5±5.9)%]均显著优于外固定组(62.4±5.1)%、(59.5±5.3)%、(65.8±5.8)%、(57.8±6.1)%、(67.9±5.9)%]，差异具有统计学意义(P<0.05)。结果显示外固定组优良率为62.96%(34/54)，与内固定组的70.37%(38/54)相比差异无统计学意义(P>0.05)。两组并发症发生率分别为12.96%(7/54)、11.11%(6/54)，差异也无统计学意义(P>0.05)。结论闭合复位外固定架固定及切开复位钢板螺丝内固定在治疗桡骨远端不稳定性骨折中各有优劣，需要根据患者基础情况、经济条件及具体伤情个体化选择治疗方案。

open reduction and internal fixation for the treatment of unstable distal radius fracture

Objective To evaluate the clinical curative effect of external fixation (EF) or open reduction and in-ternal fixation (ORIF) for the treatment of unstable distal radius fracture. Methods One hundred and eight patients of unstable distal radius fracture who were treated in Bozhou People's Hospital from January 2012 to January 2015 were se-lected. The patients were divided into two groups according to random number table (n=54), which were treated with EF (EF group) and ORIF (IF group). The operation condition, short-term efficacy, medium-term efficacy were compared be-tween the two groups. Results The operative time, blood loss, length of hospital stay, fracture healing time in EF group were (30.7±5.4) min, (55.1±8.1) mL, (7.6±2.0) d, (82.8±9.5) d, respectively, which were significantly shorter than those in IF group of (70.3±6.6) min, (80.2±9.3) mL, (12.5±2.7) d, (114.5±12.9) d, with P<0.05. Three months after the oper-ation, the VAS score of EF group was significantly higher than that of IF group (4.2±0.8) vs (3.1±0.9), P<0.05]. The radial incline, ulnar deviation, and gradient of wrist auricular surface showed statistically significant difference be-tween the two groups 3 months after operation (12.8±1.5)° vs (9.3±2.0)°, (24.1±1.8)° vs (21.2±2.0)°, (2.2±0.4) mm vs (3.0±0.5) mm, P<0.05] and one year after operation (13.5±1.6)° vs (11.2±2.1)°, (24.9±2.3)° vs (22.7±2.5)°, (0.8±0.4) mm vs (1.4 ± 0.6) mm, P<0.05]. The wrist flexion-extension, radial-ulnar deviation, pronation-supination, grip and pinch strength, and percentage of healthy side in IF group were significantly better than those in EF group (77.7 ± 5.5)% vs (62.4 ± 5.1)%, (68.4 ± 4.9)%vs (59.5 ± 5.3)%, (80.6 ± 5.0)%vs (65.8 ± 5.8)%, (73.3 ± 5.4)%vs (57.8 ± 6.1)%, (79.5 ± 5.9)%vs (67.9 ± 5.9)%, P<0.05] three months after operation. The excellent and good rate, the incidence of complication showed no statistically significant difference between the two groups 62.96%(34/54) vs 70.37%(38/54), 12.96%(7/54) vs 11.11%(6/54)]. Conclusion IF and EF has its own advantages and disadvantages in the treatment of unstable distal radius frac-ture. The therapeutic regimen should be formulated individually based on basic situation, specific circumstances, and economic condition.