外固定支架与锁定加压钢板治疗桡骨远端die-punch骨折

目的比较外固定支架与锁定加压钢板(LCP)治疗桡骨远端die-punch骨折的疗效及适应证。方法 2007年1月-2011年1月,分别采用外固定支架和LCP治疗桡骨远端die-punch骨折32例36侧,其中LCP固定19侧,外固定支架固定17侧。两组患者性别、年龄、致伤原因、骨折分类、伤后至入院时间等一般资料比较差异无统计学意义(P>0.05)。术中对塌陷的关节面均采取撬拨植骨的方法恢复桡腕关节,克氏针固定较大骨折块。比较两种方法手术前后掌倾角、尺偏角、桡腕关节面恢复情况、骨折愈合时间,术后腕关节活动范围等。结果两组患者手术切口均Ⅰ期愈合,无感染发生。患者术后均获随访,随访时间6～24个月,平均13个月。所有患者骨折愈合良好,愈合时间、术后6个月X线片掌倾角、尺偏角两组间差异均无统计学意义(P>0.05);术后6个月腕关节尺偏活动度分别为(20.8±3.6)°和(18.0±2.8)°,LCP组优于外固定支架组(P<0.05);LCP组和外固定支架组桡骨高度分别为(10.9±2.8)mm和(13.4±2.3)mm,Gartland-Werley评分分别为(5.3±2.4)分和(8.4±3.6)分,两组差异有统计学意义(P<0.05)。结论对于桡骨远端die-punch骨折,LCP可提供有效固定及早期活动,但对于关节面的塌陷及桡骨高度的恢复,外固定支架固定可提供良好的支撑作用。对于严重die-punch骨折可联合运用LCP和外固定支架等技术。

External Fixator or Locking Compression Plate for the Treatment of Die-punch Fractures in Distal End of Radius

Objective To compare the clinical efficacy and indications of external fixator and locking compression plate(LCP) for die-punch fracture of distal radius.Methods From January 2007 to January 2011,32 patients(36 cases) with die-punch fracture of distal radius were treated with external fixator and LCP,wherein LCP was used in 19 cases,and external fixtator was used in 17.There was no significant difference between the two groups in terms of patients’ sex,age,injury causes,fracture classification,injury and hospitalization time and other general information(P>0.05).The collapse of the articular surface was treated with poking bone grafting method for restoration of wrist fractures,and Kirschner wire was used to fix large fractured blocks.Then,we compared the two methods before and after surgery in terms of such indications as palm inclination,ulnar deviation,the recovery of the radiocarpal articular surface,fracture healing time,and postoperative wrist range of activities.Results The incision healed well without any infection.Patients were followed up for 6 to 24 months with an average of 13 months.Fracture healing time,palm inclination,and ulnar deviation of the two groups of patients were not significantly different(P>0.05).Six months after operation,the activity of ulnar deviation of LCP group and the external fixator group were respectively(20.8 ± 3.6) and(18.0 ± 2.8),with a significant difference(P<0.05).The Radial height of the external fixator group (13.4 ± 2.3)mm] was significantly better than that of the LCP group (10.9 ± 2.8)mm](P<0.05).Gartland-Werley scores of the LCP group (5.3 ± 2.4) points] and the external fixator group (8.4 ± 3.6) points] were also significantly different(P<0.05).Conclusions For die-punch fracture of distal radius,LCP can provide effective fixation and early activity,but to the articular surface collapse and radial length recovery,external fixation can provide a good supporting role.For serious die-punch fractures,those two methods can be combined.