经掌侧入路锁定加压钢板固定术与非手术治疗老年桡骨远端骨折的疗效对比

目的:观察比较经掌侧入路锁定加压钢板固定术与非手术治疗老年桡骨远端骨折的临床疗效.方法:选择71例老年桡骨远端骨折患者,根据患者意愿分为观察组37例和对照组34例,观察组采用经掌侧入路锁定加压钢板固定术治疗,对照组采用手法复位石膏外固定治疗,记录患者骨折复位及愈合情况,应用Cooney腕关节评分法评价腕关节功能.结果:观察组患者平均骨折愈合时间(12.1±2.4)周,对照组为(14.8±3.2)周,差异有统计学意义(P<0.05).两组患者治疗前掌倾角、尺偏角及桡骨缩短长度相似,差异无统计学意义(P>0.05);治疗6个月后,两组患者掌倾角、尺偏角及桡骨缩短长度较治疗前均好转,但观察组改善幅度较对照组更显著,差异有统计学意义(P<0.05);观察组患者Cooney腕关节评分中疼痛、活动范围、握力、屈曲/伸展活动度、功能评分方面均优于对照组,差异有统计学意义(P<0.05);观察组腕关节功能优良率94.6%,高于对照组的76.5%,差异有统计学意义(P<0.05).两组患者术后并发症发生率相似,差异无统计意义(P>0.05).结论:经掌侧入路锁定加压钢板固定术治疗老年桡骨远端骨折骨折愈合快,腕关节功能恢复好.

Efficacy Comparison betwwen Locking Compression Plate Fixation from Volar Approach and Non-operation in Treatment of Distal Fracture of Radius in Elderly Patients

Objective:To study the clinical efficacy of locking compression plate fixation from volar ap-proach vs. non-operation in treatment of distal fracture of radius in the old. Methods:Totally 71 old patients with distal fracture of radius were selected and divided into observation group ( 37 patients) and control group ( 34 patients) according to the wills of the patients. The observation group was treated with locking compres-sion plate fixation from volar approach, while the control group treated with manipulative reduction and plaster external fixation. The conditions of reduction and healing of the fracture were recorded, and the wrist joint functions evaluated by Cooney wrist joint scale. Results: The mean fracture healing times of the observation group and control group were (12.1±2.4) weeks and (14.8±3.2) weeks, respectively, and the difference was statistically significant ( P<0.05) . Before treatment, the two groups had insignificantly different palmar tilts, ulnar inclinations, and radial shortening lengths ( P>0.05);at 6 months after treatment, both groups had sig-nificantly improved palmar tilts, ulnar inclinations, and radial shortening lengths compared with those before treatment, but the observation group had significantly greater improving extents (P<0.05); the observation group had significantly better Cooney wrist joint scores than the control group, including pain, range of mo-tion, hand strength, inflexion/expansion activity and function (P<0.05); and the observation group had a significantly higher excellent rate of wrist joint function than the control group (94.6% vs. 76.5%, P<0.05). The two groups had insignificantly different incidences of postoperative complications ( P>0.05) . Conclusion:Locking compression plate fixation from volar approach in treatment of distal fracture of radius in the old has advantages of rapider fracture healing and better wrist joint function recovery. Volar locking compression plate fixation in the treatment of elderly patients with distal radius fracture has healing fast and wrist joint function recovery advantages.