闭合复位支架外固定与切开复位掌侧锁定钢板内固定治疗桡骨远端粉碎性骨折的效果(1)
【摘要】 目的：比较闭合复位支架外固定与切开复位掌侧锁定钢板内固定治疗桡骨远端粉碎性骨折的效果。方法：选取2017年1月-2018年9月于笔者所在医院住院治疗的桡骨远端粉碎性骨折患者100例，根据手术方式分为外固定组46例与内固定组54例，比较两组一般情况、手术前后Cooney腕关节评分和治疗效果。结果：内固定组手术时间和住院时间均长于外固定组(P<0.05);两组术后感染率比较，差异无统计学意义(P>0.05);内固定组术后Cooney腕关节评分均高于外固定组(P<0.05);内固定组优良率为70.4%，显著高于外固定组的50.0%(P<0.05)。结论：与闭合复位支架外固定相比，采用切开复位掌侧锁定钢板内固定治疗桡骨远端粉碎性骨折的手术时间及住院时间虽较长，但术后腕关节功能和治疗效果更佳。
【关键词】 桡骨远端粉碎性骨折 闭合复位支架外固定 掌侧锁定钢板内固定 Cooney腕关节评分
[Abstract] Objective： To compare the effect of closed reduction and external fixation and open reduction and internal fixation with volar locking plate in the treatment of comminuted fracture of the distal radius. Method： From January 2017 to September 2018， 100 patients with comminuted fracture of the distal radius who were hospitalized in our hospital were divided into the external fixation group (46 cases) and the internal fixation group (54 cases) according to the operation mode. General conditions， Cooney wrist scores before and after operation and therapeutic effect were compared between the two groups. Result： The operation time and hospitalization time of the internal fixation group were longer than those of the external fixation group (P<0.05). Postoperative infection rates of the two groups were compared， and the difference was not statistically significant (P>0.05). The postoperative Cooney wrist scores of the internal fixation group were higher than those of the external fixation group (P<0.05). The excellent and good rate of the internal fixation group was 70.4%， which was higher than 50.0% of the external fixation group (P<0.05). Conclusion： Compared with closed reduction and external fixation， open reduction and internal fixation with volar locking plate for comminuted fracture of the distal radius has longer operation time and hospitalization time， but better postoperative wrist function and therapeutic effect.
桡骨远端粉碎性骨折是指桡骨远端2 cm处的骨折，易伴关节面坍塌而引起骨块转移，修复难度大[1]。常用的修复方法包括手法复位夹板外固定、支架外固定、切开复位掌侧锁定钢板内固定等。支架外固定手术方法简单，总体效果尚可，但对于腕关节功能恢复、无韧帶附着的骨块复位等仍不理想[2]。掌侧锁定钢板内固定操作复杂，在经验不足或手术要求较为精细的情况下可能会进一步加重软组织损伤，但对骨折块固定效果较好，利于早期功能锻炼。本文主要比较上述两种手术方法的效果，将结果报道如下。
1 资料与方法
1.1 一般资料
选取2017年1月-2018年9月于笔者所在医院住院治疗的桡骨远端粉碎性骨折患者100例。纳入标准：(1)初次骨折，符合桡骨远端粉碎性骨折的诊断标准;(2)年龄30～60岁;(3)单臂骨折，AO分型为C2、C3型;(4)符合手术指征。排除标准：(1)合并其他部位骨折;(2)合并严重心、脑、肾等脏器功能不全;(3)合并恶性肿瘤或凝血功能障碍等;(4)病理性骨折。根据手术方式分为外固定组46例，内固定组54例。外固定组男18例，女28例;平均年龄(49.40±4.20)岁;C2型18例，C3型28例;左侧骨折20例，右侧骨折26例。内固定组男24例，女30例;年龄(49.52±4.18)岁;C2型22例，C3型32例;左侧骨折25例，右侧骨折29例。两组性别、年龄、AO分型、骨折部位比较，差异均无统计学意义(P>0.05)，具有可比性。, http://www.100md.com(姚沛全 余颖锋 张贤森)
【关键词】 桡骨远端粉碎性骨折 闭合复位支架外固定 掌侧锁定钢板内固定 Cooney腕关节评分
[Abstract] Objective： To compare the effect of closed reduction and external fixation and open reduction and internal fixation with volar locking plate in the treatment of comminuted fracture of the distal radius. Method： From January 2017 to September 2018， 100 patients with comminuted fracture of the distal radius who were hospitalized in our hospital were divided into the external fixation group (46 cases) and the internal fixation group (54 cases) according to the operation mode. General conditions， Cooney wrist scores before and after operation and therapeutic effect were compared between the two groups. Result： The operation time and hospitalization time of the internal fixation group were longer than those of the external fixation group (P<0.05). Postoperative infection rates of the two groups were compared， and the difference was not statistically significant (P>0.05). The postoperative Cooney wrist scores of the internal fixation group were higher than those of the external fixation group (P<0.05). The excellent and good rate of the internal fixation group was 70.4%， which was higher than 50.0% of the external fixation group (P<0.05). Conclusion： Compared with closed reduction and external fixation， open reduction and internal fixation with volar locking plate for comminuted fracture of the distal radius has longer operation time and hospitalization time， but better postoperative wrist function and therapeutic effect.
桡骨远端粉碎性骨折是指桡骨远端2 cm处的骨折，易伴关节面坍塌而引起骨块转移，修复难度大[1]。常用的修复方法包括手法复位夹板外固定、支架外固定、切开复位掌侧锁定钢板内固定等。支架外固定手术方法简单，总体效果尚可，但对于腕关节功能恢复、无韧帶附着的骨块复位等仍不理想[2]。掌侧锁定钢板内固定操作复杂，在经验不足或手术要求较为精细的情况下可能会进一步加重软组织损伤，但对骨折块固定效果较好，利于早期功能锻炼。本文主要比较上述两种手术方法的效果，将结果报道如下。
1 资料与方法
1.1 一般资料
选取2017年1月-2018年9月于笔者所在医院住院治疗的桡骨远端粉碎性骨折患者100例。纳入标准：(1)初次骨折，符合桡骨远端粉碎性骨折的诊断标准;(2)年龄30～60岁;(3)单臂骨折，AO分型为C2、C3型;(4)符合手术指征。排除标准：(1)合并其他部位骨折;(2)合并严重心、脑、肾等脏器功能不全;(3)合并恶性肿瘤或凝血功能障碍等;(4)病理性骨折。根据手术方式分为外固定组46例，内固定组54例。外固定组男18例，女28例;平均年龄(49.40±4.20)岁;C2型18例，C3型28例;左侧骨折20例，右侧骨折26例。内固定组男24例，女30例;年龄(49.52±4.18)岁;C2型22例，C3型32例;左侧骨折25例，右侧骨折29例。两组性别、年龄、AO分型、骨折部位比较，差异均无统计学意义(P>0.05)，具有可比性。, http://www.100md.com(姚沛全 余颖锋 张贤森)
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