三种不同固定方式治疗桡骨远端粉碎性骨折的骨愈合

背景:目前研究认为桡骨远端骨折保守治疗对腕关节功能恢复有明显的影响,临床上治疗多倾向于解剖复位桡骨远端关节面、恢复掌倾角及尺偏角,从而有益于腕关节功能恢复。目的:评价3种不同方式固定桡骨远端粉碎性骨折后腕关节结构功能恢复差异及其优缺点。方法:临床收治桡骨远端粉碎性骨折患者88例,其中闭合复位石膏外固定35例,闭合复位外固定架外固定28例,切开复位钢板内固定25例,分别对骨折愈合时间、腕关节骨性解剖结构及功能恢复程度进行评估。结果与结论:所治患者均获骨愈合,愈合时间石膏组为(11.2±2.8)周,外固定架组为(11.8±3.0)周,钢板组为(10.8±2.6)周,外固定架组、钢板组与石膏组比较,差异无显著性意义(P>0.05);术后6个月X射线评价钢板组桡骨远端掌倾角及尺偏角大于外固定架组、石膏组,差异有显著性意义(P<0.05);固定后6个月腕关节功能按改良Gartland and Werley评分标准评价优良率,石膏组为54%,外固定架组为75%,钢板组为92%,外固定架组、石膏组与钢板组比较,差异有显著性意义(P<0.05)。结果可见3种方式固定桡骨远端粉碎性骨折后骨愈合时间无明显差异,钢板内固定治疗能有效维持桡骨远端骨性解剖结构,对腕关节功能恢复优于外固定架及石膏外固定。

Bone healing of distal radius comminuted fracture treated with three different fixation methods

BACKGROUND： Studies have suggested that conservative treatment of distal radius fractures has a significant impact on wrist functional recovery, clinical treatment often focus on the anatomical reduction of the articular surface of the distal radius, restore palmar inclination and ulnar inclination, thus benefit to the functional recovery of the wrist. OBJECTIVE： To evaluate the recuperative effects of wrist in distal radius comminuted fracture with three fixation methods, and its advantages and disadvantages. METHODS： Eighty-eight patients of distal radius comminuted fractures were selected, 35 patients underwent closed reduction and plaster external fixation, 28 patients underwent external fixing frame, and 25 patients underwent open reduction and plate fixation. The healing time, wrist bone anatomical structure and functional recovery were retrospectively analyzed. RESULTS AND CONCLUSION： All the patients were treated for union. The healing time of fracture was average （11.2±2.8） weeks in plaster fixation group, the time was average （11.8±3.0） weeks in external fixing frame group, and average （10.8±2.6） weeks in plate fixation group. There was no significant difference of fracture healing time compared with plaster fixation group （P 0.05）. The X-ray film at 6 months after operation showed the palmar inclination and ulnar deviation of distal radius in the plate fixation group were higher than those in the external fixing frame group and plaster fixation group, and the differences were significant （P 0.05）. The excellent and good rate of wrist function was evaluated with the modified Gartland and Werley standards. The excellent and good rate of plaster fixation group was 54%, the external fixing frame group was 75%, and the plate fixator group was 92%. There were significant differences of the excellent and good rate of distal radius compared with plate fixation group （P 0.05）. The results showed that there was no significant difference of the healing time of distal radialis comminuted fracture among three methods of fixation. The bone anatomical structure of distal radialis fracture was effectively maintained with plate fixation, and the recovery of wrist joint function with plate internal fixation was better than external fixing frame or plaster fixation.