不同手术方式治疗桡骨远端C型骨折的疗效分析

目的 桡骨远端C型骨折为临床较常见骨折类型，其治疗方式主要包括外固定支架和掌侧锁定钢板内固定，选择何种术式仍存在争议，通过对比分析2种术式的临床疗效，为2种术式的临床应用提供参考。 方法 收集杭州师范大学附属医院2011年1月—2014年1月收治的桡骨远端C型骨折患者84例，随机分为外固定组42例，行外固定支架治疗，内固定组42例，行掌侧锁定钢板内固定治疗。对比分析2组患者的手术时间、术中出血量、住院时间、骨折愈合时间、尺偏角、掌倾角、桡骨高度以及术后6个月、术后1年的Cooney腕关节评分。 结果 与内固定组相比，外固定组患者手术时间(30.2±8.9) min]、术中出血量(21.7±7.3) ml]、住院时间(4.3±1.2) d]及骨折愈合时间(11.9±4.4)周]明显更少(P＜0.05),外固定组的尺偏角(20.5±3.1)°]、桡骨高度(13.7±1.8) mm]明显大于内固定组，而掌倾角明显更小(10.2±2.9)°](P＜0.05)，术后6个月Cooney腕关节评分在活动范围、握力方面评分明显更高(P＜0.05)；术后12个月Cooney腕关节评分在功能、活动范围、屈曲/伸展活动度及握力方面评分明显更高(P＜0.05)；术后1年外固定组优良率为90.5%，内固定组优良率为81.0%，2组患者的优良率差异有统计学意义(P＜0.05)。 结论 掌侧锁定钢板内固定和外固定支架治疗桡骨远端C型骨折均能取得较好的疗效，而外固定支架具有术后恢复快、创伤小、腕关节活动影响小及优良率高等优势。 

Efficacy analysis of external fixator and volar locking-plate fixation in treatment of type C fracture of distal radius

Objective The type C fracture of distal radius were the common types of fractures,its treatment methods mainly include external fixation and volar locking-plate internal fixation.The choice of operation type is still controversial.This paper will compare the clinical efficacy of the two surgery types,and provide a reference for the clinical application. Methods A total of 84 cases of type C fracture of distal radius were collected from January,2011 to January,2014 in our hospital.According to the surgery method,42 cases were assigned into external fixation group,another 42 cases into internal fixation group.The operative time,blood loss,hospitalization time,fracture healing time,ulnar deviation,palmar tilt,radial height,and Cooney wrist score at 6 months and 12 months after the operation between the two groups were compared. Results Compared with internal fixation,the external fixation group was with less operation time (30.2±8.9)min,amount of bleeding during operation (21.7±7.3)ml,hospitalization time (4.3±1.2)d and fracture healing time (11.9±4.4)weeks(P<0.05),while the external fixation group had great ulnar deviation (20.5±3.1)degree and radial height (13.7±1.8)mm,but the palmar tilt was significantly smaller (10.2±2.9) as compared with the internal fixation group(P<0.05);6 months after the operation,Cooney wrist score for the range of motion and grip strength score was significantly higher(P<0.05);the postoperative Cooney wrist score 12 months after the operation for the function,scope of activities,flexion/extension activity and grip strength were significantly higher(P<0.05);One years after the operation,the excellent and good rate of external fixation group was 90.5%,and of the internal fixation group was 81.0%,the differences between the two groups was significant(P<0.05). Conclusion Volar locking-plate internal fixation and external fixator for type C distal fractures of distal radius can achieve good effect.The external fixator is with advantages of quick recover after operation,small trauma,good wrist joint activities and higher excellent rate.