两种方法治疗老年桡骨远端不稳定型骨折的疗效比较

目的 比较植骨联合钢板内固定与闭合复位外固定支架固定治疗老年桡骨远端不稳定型骨折的疗效. 方法 2008年1月至2009年6月间收治36例(41侧)老年桡骨远端不稳定型骨折患者,其中26例(30侧)采用钢板内固定(内固定组),男10例11侧,女16例19侧;年龄51～73岁,平均61.6岁;左11侧,右19侧.按AO分型:A3型4侧;B1型4侧,B2型6侧,B3型4侧;C1型3侧,C2型4侧,C3型5侧.10例(11侧)采用闭合复位外固定支架固定(外固定组),男3例3侧,女7例8侧;年龄53～78岁,平均56.2岁;左4侧,右7侧.按AO分型:A3型2侧;B1型2侧,B2型1侧,B3型2侧;C1型1侧,C2型1侧,C3型2侧.受伤至手术时间平均为5.1 h.内固定组患者根据骨折类型及主要骨块的移位方向选用掌侧或背侧入路钢板内固定.外固定组均采用闭合手法复位外固定支架固定. 结果 36例患者术后获3～16个月(平均9.6个月)随访.根据Dienst功能评分标准评定疗效:内固定组优19侧,良9侧,可2侧,优良率为93.3%;外固定组优2侧,良4侧,可1侧,差4侧,优良率为54.5%,两组比较差异有统计学意义(X2=8.553,P=0.030). 结论 对于桡骨远端不稳定型骨折,钢板内固定的疗效优于闭合复位外固定支架.

A comparison of two methods of treating unstable distal radius fractures in the aged

Objective To compare the clinical results of internal plating plus bone grafting and close reduction plus external fixator in the treatment of unstable distal radius fractures in the aged patients. Methods A total of 36 patients with 41 unstable fractures of distal radius were treated from January 2008 to June 2009. Internal plating plus bone grafting was used for 26 patients (30 fractures), including 10 males (11 fractures) and 16 females ( 19 fractures), with an average age of 61.6 years. Close reduction plus external fixator was used for 3 males (3 fractures) and 7 females (8 fractures), with an average age of 56. 2 years. The time intervals between injury and operation ranged from 3 to 8 hours in this series. Results All patients were followed up for an average of 9.6 months (range, 3 to 16 months). According to the Dienst criteria, the internal plating group had an excellent to good rate of 93.33% while the close reduction group 54. 54%. The difference was statistically significant between the 2 groups (X2 = 8. 553, P = 0. 030) . Conclusion Internal plating plus bone grafting may result in better results than close reduction plus external fixator for aged patients with unstable distal radius fractures.