伸直型与屈曲型桡骨远端骨折手术疗效对比

目的:比较掌侧锁定接骨板内固定治疗伸直型与屈曲型桡骨远端骨折的疗效。方法:自2015年1月至2018年6月采用掌侧锁定接骨板内固定治疗桡骨远端骨折患者103例,根据原始骨折移位方向分为伸直型(Colles)骨折组和屈曲型(Smith)骨折组。Colles骨折组68例,其中男24例,女44例;年龄20~79(59.0±13.4)岁;根据AO分型,A2型9例,A3型13例,C1型16例,C2型17例,C3型13例;受伤至手术时间2~9(3.9±0.8)d。Smith骨折组35例,其中男15例,女20例;年龄27~87(60.1±15.3)岁;AO分型,A2型4例,A3型7例,C1型14例,C2型5例,C3型5例;受伤至手术时间2~6(4.1±0.9)d。比较两组患者的手术时间、骨折愈合时间及并发症情况;分别于术后6、12周,6和8个月采用肩臂手功能障碍评分量表(disabilities of arm,shoulder and hand,DASH)评估患肢功能恢复情况;术后8个月测量并比较两组患者掌倾角、尺偏角、桡骨高度,并采用Mayo评分评价腕关节功能恢复情况。结果:所有患者获得随访,时间8~30(14.8±4.3)个月,两组随访时间比较差异无统计学意义(P>0.05)。两组患者手术时间、骨折愈合时间及并发症情况比较差异无统计学意义(P>0.05)。术后6、12周Colles骨折组DASH评分分别为(37.24±5.08)分、(19.68±4.55)分,Smith骨折组分别为(39.05±4.79)分、(23.44±4.21)分,Colles骨折组优于Smith骨折组(P<0.001);术后6、8个月两组DASH评分比较差异无统计学意义(P>0.05)。术后8个月Smith骨折组掌倾角(11.1±3.1)°优于Colles骨折组(8.6±4.1)°,而尺偏角、桡骨高度比较差异无统计学意义。术后8个月两组Mayo评分及评级比较差异无统计学意义(P>0.05)。结论:Colles骨折与Smith骨折通过掌侧锁定接骨板均可获得良好复位和固定;两组术后影像学参数均得到满意恢复;Smith骨折组掌倾角恢复优于Colles骨折组,Colles骨折组早期功能恢复优于Smith组,但两组远期腕关节功能、术后并发症发生率无明显差异。

Comparison of surgical effects between extension and flexion type of distal radius fracture

Objective: To compare therapeutic effects of internal fixation with volar locking plate in treating extension and flexion type of distal radius fracture(DRF).Methods: From January 2015 to June 2018,103 patients with DRF were retrospectively analyzed. According to original fracture displacement direction,patients were divided into extension fracture(Colles) group and flexion fracture (Smith) group. In Colles fracture group,there were 24 males and 44 females aged from 20 to 79 years old with an average of(59.0±13.4) years old;according to AO classification,9 patients of type A2,13 patients of type A3,16 patients of type C1,17 patients of type C2 and 13 patients of type C3;the time from injury to operation ranged from 2 to 9 days with an average of (3.9±0.8) days. In Smith fracture group,there were 15 males and 20 females,aged from 27 to 87 years old with an average of (60.1±15.3) years old;according to AO classification,4 patienst of A2,7 patients of A3,14 patients of C1,5 patients of C2 and 5 patients of C3;the time from injury to operation ranged from 2 to 6 days with an average of (4.1±0.9) days. Operation time,fracture healing time and postoperative complications were recorded between two groups. Disabilities of arm,shoulder and hand (DASH) score at 6 and 8 weeks,6 and 8 months were used to evaluate functional recovery of affected limbs during each follow-up. Volar tilt,radial inclination and radius height were measured at 8 months after operation. Mayo score was measured at 8 months after operation to evaluate recovery of limb function.Results: All patients were followed up for 8 to 30 months with an average of (14.8±4.3) months,and no difference in follow-up between two groups (P>0.05). There were no statistical differences in operation time,fracture healing time and postoperative complications between two groups(P>0.05). DASH score at 6 and 12 weeks in Colles fracture group were (37.24±5.08) and (19.68±4.55),while in Smith fracture group were (39.05±4.79) and (23.44±4.21);Colles fracture group was better than that of Smith fracture group(P<0.001);while there were no differences in DASH score at 6 and 8 months between two groups(P>0.05). Volar tilt of Smith fracture group (11.1±3.1)° was better than that of Colles fracture group (8.6±4.1)°,and there were no significant difference in radial inclination and radius height between two groups(P>0.05). Also there was no significant difference in Mayo score between two group(P>0.05).Conclusion: Patients with Colles fracture and Smith fracture could receive good reduction and fixation through volar locking plate. The radiographic parameters of both groups recovered satisfactorily after operation. Recovery of volar tilt of Smith fracture group is better than that of Colles fracture group,and early recovery function of Colles fracture group is better than that of Smith group,but there is no significant difference in long-term wrist joint function and incidence of postoperative complications between two groups.