跨腕关节钢板与外固定支架治疗桡骨远端粉碎骨折的疗效比较

目的 比较跨腕关节钢板与外固定支架治疗桡骨远端粉碎骨折的疗效.方法 2007年3月至2010年4月采用跨腕关节钢板(钢板组)和外固定支架(外固定支架组)治疗57例桡骨远端粉碎骨折患者.其中钢板组28例,男18例,女10例;年龄21～67岁,平均44.7岁;左侧17例,右侧11例;C2型8例,C3型20例.外固定支架组29例,男19例,女10例;年龄21～69岁,平均49.4岁;左侧12例,右侧17例;C2型13例,C3型16例.对两组患者术中及住院期间的各项指标、术前与术后的影像学结果、临床疗效结果及并发症进行对比分析.结果 57例患者术后获12～35个月(平均24.4个月)随访.钢板组较外固定支架组手术时间长、术中出血量多、切口长度相对较长,两组比较差异均有统计学意义(P＜0.05).两组患者掌倾角、尺偏角、桡骨茎突长度在术前、术后及随访时比较差异无统计学意义(P＞0.05).两组患者关节面台阶术前、术后2 d比较差异无统计学意义(P＞0.05),术后12个月随访比较差异有统计学意义(P＜0.05).两组患者术后6个月、末次随访时旋前、旋后、掌屈、背伸活动范围比较,差异均无统计学意义(P＞0.05).根据Jakim评分标准,钢板组优于外固定支架组,但两组比较差异无统计学意义(P＞0.05).外固定支架组并发症发生率显著高于钢板组,两组比较差异有统计学意义(P＜0.05).结论 跨腕关节钢板与外固定支架治疗桡骨远端粉碎骨折,复位和治疗效果相当,跨腕关节钢板创伤较大,但复位稳定性好,并发症较少.

Transarticular plating versus external fixation in treatment of comminuted fractures of the distal radius

Objective To compare the outcomes of transarticular plating and external fixation for the treatment of comminuted fractures of the distal radius.Methods From March 2007 to April 2010, 57patients with comminuted fractures of the distal radius were treated with transarticular plating (TP) and external fixation (EF).In the TP group, there were 18 males and 10 females, with a mean age of 44.7 years (range, 21 to 67 years); the fracture affected 17 left and 11 right radiuses; there were 8 cases of type C2 and 20 cases of C3.In the EF group, there were 19 males and 10 females, with a mean age of 49.4 years (range,21 to 69 years); the fracture affected 12 left and 17 right radiuses; there were 13 cases of type C2 and 16 cases of C3.The preoperative and postoperative radiographic outcomes, clinical outcomes and postoperative complications were statistically compared between the 2 groups.Results All the patients were followed up for 12 to 35 months (average, 24.4 months).The TP group had significantly longer operation time, larger perioperative blood loss and longer average incision length than EF group ( P ＜ 0.05) .There were no significant differences in the volar tilt, the radial tilt and the length of styloid process before operation, after operation and at follow-up between the 2 groups ( P ＞ 0.05 ).In the articular set-off, there were no significant differences preoperation and 2 days postoperation between the 2 groups ( P ＞ 0.05), but there was a significant difference at the follow-up 12 months postoperation ( P ＜ 0.05).There were no significant differences in pronation, supinatian, volar flexion, dorsal extension, or Jakim scores between the 2 groups at 6 months postoperation and the last follow-up ( P ＞ 0.05) .EF group had significantly more complications than TP group ( p ＜ 0.05).Conclusions Transarticular plating is believed to be as good as external fixation for the treatment of comminuted fractures of the distal radius in reduction and therapeutic outcomes.However, transarticular plating may lead to better stability of reduction and less complications, though with more invasion.