掌侧锁定板内固定和外固定支架治疗桡骨远端关节内骨折的疗效比较

目的比较采用掌侧锁定板内固定与外固定架外固定治疗桡骨远端关节内骨折的疗效。方法 43例桡骨远端关节内骨折患者,其中男性31例,女性12例;年龄18～68岁,平均年龄35.16岁。分为2组,即内固定术组（采用掌侧锁定板）和外固定支架术组。回顾分析采用切开复位掌侧锁定板内固定术和采用闭合复位或者有限切开外固定支架术（其中11例结合克式针内固定）治疗情况。通过术后不同时期（术后2～3d、1个月、2个月、3个月、6个月、12个月）X射线片测量、关节活动度、握持力量等进行比较;对患者主观功能评估使用上肢、肩、腕伤残（DASH）评分。平均随访时间15个月（8～18个月）。结果放射学评价方面,内固定术组较外固定支架术组掌倾角恢复好,桡骨长度丢失情况内固定术组好于外固定支架术组,差异有统计学意义（P〈0.05）;术后末次随访内固定术组握力和关节屈伸活动度较外固定支架术组恢复更好,差异有统计学意义（P〈0.05）;末次随访DASH评分,内固定术组为7.9±6.1,外固定支架术组为14.1±5.4。内固定术组无明显术后并发症;外固定支架术组再手术1例,第二掌骨骨折1例,术后钉道感染2例。结论相比较来说,掌侧锁定钢板治疗桡骨远端关节内骨折效果更好。

Comparison of palmar locking plate and external fixation for intra-articular distal radius fractures

Objective To compare the curative effect of palmar locking plate and external fixation in the treatment of intra articular distal radius fractures.Methods A total of 43 patients with intra-articular distal radius fractures were enrolled,included 31 males and 12 females,who were 18-68 years old with a mean age of 35.16.All of them were divided into 2 groups： internal fixation（palmar locking plate fixation） group and external fixation group.The retrospective analysis of intra-articular distal radius fractures with operative treatment（11 patients with K-wire augmented） were performed.Twenty-five patients underwent open reduction and palmar locking plate fixation,and eighteen patients underwent closed or limited open reduction external fixation（11 patients with K-wire augmented）.The different period of X ray film measurement（2-3 days,1 month,2 months,3 months,6 months and 12 months after operation）,joint range of motion and grip strength were measured and compared.The subjective functional assessment was made by Disabilities of the Arm,Shoulder and Hand（DASH） scale,and the mean follow-up period was 15 months（8 18 months）.Results Accorded to radiographic measurements,the palmar angulation and the loss of radial length in internal fixation group were better than that in external fixation group,there were significant difference between 2 groups（P 0.05）;and the final flexion-extension ranges of motion and grip strengths at followed-up were better than that of the external fixation group（P 0.05）.The final mean DASH score in internal fixation group was 7.9 ± 6.1,and 14.1 ± 5.4 in external fixation group.There were no complications in internal fixation group,in external fixation group,1 patient performed reoperation,1 patient got the second palmar bone fracture,and 2 patients had superficial pin tract infections.Conclusion It is demonstrated that the palmar locking plate fixation has better effect than external fixation for treating intra-articular distal radius fractures.