锁定加压钢板和外固定支架治疗桡骨远端C型骨折的疗效比较

目的：探讨锁定加压钢板和外固定支架治疗桡骨远端C型骨折的临床疗效。方法：自2009年1月至2010年6月，分别采用锁定加压钢板和外固定支架两种方法治疗76例桡骨远端骨折患者，其中54例获随访，男29例，女25例；年龄24～68岁，平均45_31岁。采用锁定加压钢板内固定治疗29例（内固定组），按照A0分型：C1型8例，C2型7例，C3型14例。采用外固定支架治疗25例（外固定支架组），按照A0分型：C1型6例，C2型8例，C3型11例。比较术后桡骨高度、掌倾角、尺偏角，采用改良Gartland-Werley（GW）评分对术后6、12个月的腕关节功能进行评定。结果：术后除外固定支架组有2例患者发生钉道感染外，其余患者创口均愈合良好。54例患者获随访，时间12~24个月，平均21-3个月。内固定组、外固定支架组术后桡骨高度分别为（9．60±0．72）mm、（9．40±0．70）mm，掌倾角分别为（9．55±0．80）。、（9．47±0．71）。，尺偏角分别为（21．40±0．78）。、（21．20±0．73）°，两组比较差异无统计学意义（P〉0．05）。术后6个月改良Gartland-Werley（GW）评分标准，内固定组（3．31±1．17）分和外固定支架组（5．56±1．58）分，两组比较差异有统计学意义（t=-5．99，P〈0．05）。术后12个月改良Gartland-Werley（GW）评分，内固定组（2．66±1．01）分和外固定支架组（3．08±1．00）分，两组比较差异无统计学意义（t=-1．55，P〉0．05）。结论：对于桡骨远端C型骨折，两种固定方式均能获得较好疗效，锁定加压钢板短期疗效明显，远期疗效两种固定方式无明显差异，对于桡骨远端严重粉碎骨折无法用钢板内固定时，外固定支架是较好的选择。

Treatment type C fracture of the distal radius with locking compression plate and external fixators

Objective: To compare efficacy of unilateral external fixators and locking compression plates in treating type C fractures of the distal radius. Methods: From January 2009 to June 2010,76 patients with distal radius fracture were treated with LCP and external fixators,54 patients were followed up. Among them,29 cases were male and 25 cases were female with an average age of 45.31(ranged,24 to 68) years old. There were 29 patients in LCP group. According to AO classification,8 cases were type C1,7 cases were type C2 and 14 cases were type C3. There were 25 cases in external fixators group. According to AO classification,6 cases were type C1,8 cases were type C2 and 11 cases were type C3. Radial height,volar tilt and radial inclination were compared,advanced Gartland-Werley scoring were used to assessed wrist joint function after 6 and 12 months' following up. Results: Two cases were suffered from nail infection in external fixators group. Fifty-four patients were followed up from 12 to 24 months with an average of 21.3 months. Radial height was(9.60±0.72) mm,volar tilt was(9.55±0.80)° and radial inclination was(21.40±0.78)° in LCP group,while those were(9.40±0.70) mm,(9.47±0.71)° and(21.20±0.73)° in external fixtors group,and with no statistical significance(P>0.05). Advanced Gartland-Werley score after 6 months' following up was 3.31±1.17 in LCP group,5.56±1.58 in external fixtors group,and with significant difference(t=-5.99,P<0.05);after 12 months' following up,advanced Gartland-Werley score was respectively 2.66±1.01 and 3.08±1.00,but with no statistical meaning(t=-1.55,P>0.05). Conclusion: LCP and external fixtors can receive good curative effects in treating type C distal radius fracture,and LCP can obtain obviously short-term efficacy,while there is no significant difference between two groups in long-term results. For serious distal radius comminuted fracture which unable to plate internal fixation,external fixators is a better choice.