加压钢板结合人工骨与外固定治疗陈旧性C型桡骨远端骨折的临床疗效观察

目的：通过对比加压钢板结合注射用人工骨及外固定治疗陈旧性C型桡骨远端骨折后腕关节功能恢复情况,探讨两种方法治疗的优缺点。方法：2009年2月-2011年3月收治24例单侧C型陈旧性桡骨远端闭合骨折患者,其中闭合复位有限切开外固定治疗（外固定组）14例,切开复位加压钢板结合人工骨治疗（加压钢板组）10例,对2组患者骨折愈合时间、愈合后腕关节活动范围以及握力,应用Gartland/Werley腕关节评分法进行评分进行临床评定。结果：患者术后均获得随访,随访时间6-20个月,X线片示骨折均愈合,骨折愈合时间外固定组为（10.6±2.1）周,加压钢板组（11.6±2.0）周,2组对比差异无统计学意义（P〉0.05）;术后3个月外固定组掌倾角6.2°±2.0°、尺偏角17.0°±4.1°;加压钢板组8.6°±2.7°、尺偏角21.3°±2.1°,2组对比差异有统计学意义（P〈0.05）。疗效按Gartland/Werley腕关节评分：外固定组：优8例,良3例,可2例,差1例,优良率78.6%;加压钢板组：优8例,良1例,可1例,差0例,优良率90%.结论：外固定组与加压钢板组比较,骨折愈合时间无差异,且均可获得满意的腕关节功能,但加压钢板组能更好的恢复桡骨远端的解剖结构,坚强固定、并发症少、术后患肢功能恢复良好。

Observation of Clinical Efficacy of Type-C Old Distal Radius Fractures Treated with Compression Plate with Artificial Bone and External Fixation

Objective:To evaluate the clinical effects of Type-C old distal radius fractures treated by external fixator and compression plate.Methods:24 patients with Type-C old distal radius fractures were treated from February 2009 to March 2011.14 patients were treated with external fixator,and 10 patients were treated with open reduction,internal fixation and injectable artificial bones.There were no significant differences(P>0.05) in sex,age,disease course and fracture classification in the two groups.The healing time,active range of motion of the wrist,grip strength,wrist score by Gartland/Werley wrist scoring systems were evaluated for all the patients.Results:All patients were followed up for 6-20 months.The fracture healing time was 8 to 15 weeks.There were no significant differences(P>0.05) in fracture healing time between the two groups.At the end of the follow-up,the mean of angle of inclination in the palmar were respectively 6.2°±2.0°,8.6°±2.7°;and the mean of angle of inclination in the ulnaris were respectively 17.0°± 4.1°,21.3°±2.1°.There were significant differences(P<0.05) between two groups.8 cases were excellent in the Gartland/Werley score in the external fixator group,3 cases good,2 cases fair,1 cases poor,and the excellent and good rate was 78.6%;8 cases were excellent in the internal fixation group,1 cases good,1 cases fair,no poor,and the excellent and good rate was 90 %.Conclusions:Open reduction and closed reduction can all achieve satisfactory functional outcomes,but the treatment of unstable fracture of the distal radius using compression plate with injectable artificial bones provides anatomical reduction,reliable fixation,fewer complications,and satisfactory effect.Partial daily activities can be restored after operation.