LCP钢板与外固定架治疗C型桡骨远端骨折的疗效比较

  目的 比较LCP钢板与外固定架治疗C型桡骨远端骨折的疗效。方法 回顾性分析2007年10月至2010年10月分别采用LCP钢板和外固定架治疗C型桡骨远端骨折的病例。其中LCP组38例，男13例，女25例；年龄23~65岁，平均45.1岁；按AO/OTA分型：C1型15例，C2型18例，C3型5例。外固定组26例，男12例，女14例；年龄25~60岁，平均47.1岁；按AO/OTA分型：C1型11例，C2型13例，C3型2例。比较两组术后影像学指标、功能指标，并采用Gartland-Werley功能评分标准对术后疗效进行评估。结果 所有患者均获得随访，随访时间LCP组12~36个月，平均23.8个月；外固定组12~44个月，平均31.2个月。X线片均显示两组骨折全部愈合。两组患者尺偏角、桡骨高度、腕关节背伸、掌屈、尺偏、桡偏、旋前、旋后及Gartland-Werley评分均无显著性差异。LCP组掌倾角11.71°±3.02°，外固定组掌倾角7.15°±2.98°，LCP组优于外固定组。LCP组伤口感染2例，正中神经损伤1例，固定松动1例；外固定组钉道感染3例，固定松动1例，腕关节僵硬2例。结论 两种固定方式治疗C型桡骨远端骨折均可达到较为满意的临床效果，LCP钢板术后影像学结果稍好，固定可靠。临床可根据患者具体情况选择治疗方式。

Comparison of locking compression plate versus external fixator in the treatment of AO type-C distal radial fractures

Objective To compare the clinical effects of the volar locking compression plate (LCP) and external fixator in the treatment of the AO type-C distal radial fractures. Methods From October 2007 to October 2010, 64 cases of AO type-C distal radial fractures which had been treated with volar LCP and external fixator were retrospectively analyzed respectively. LCP group consisted of 38 patients, including 13 males and 25 females with an average age of 45.1 years. According to AO/OTA classification, there were 15 type-C1, 18 type-C2, and 5 type-C3. External fixator group consisted of 26 patients, including 12 males and 14 females with an average age of 47.1 years. There were 11 type-C1, 13 type-C2, and 2 type-C3. Outcomes were assessed by radiographic parameters, function parameters, and Gartland-Werley functional score. Results All the patients were followed up. X-rays showed all fractures healed. LCP group was followed up for an average of 23.8 months. External fixator group was followed up for an average of 31.2 months. According to the Gartland-Werley score, the excellent and good rate was 81.6% in the LCP group and 76.9% in the external fixator group, with a Gartland-Werley score of 4.50?3.55 and 5.04?3.74 respectively. There were no significant differences in wrist flexion, extension, ulnar deviation, radial deviation, pronation, supination, the parameter of ulnar inclination and radial height and the Gartland-Werley score. The volar tilt was better in the LCP group than in the external fixator group. There were 2 cases of wound infection, 1 case of median nerve injury, 1 case of plate loosening in LCP group; 3 cases of pin tract infection, 1 case of fixator loosening, and 2 cases of wrist stiffness in the external fixator group. Conclusion LCP group had better imaging outcomes with a reliable fixation, but both of the groups can achieve satisfactory clinical results. The choices of treatment method depend on the patient's clinical conditions.