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[1]王仲鋒,王曉,李國軍,等.3種不同固定方式治療橈骨遠(yuǎn)端C型骨折的療效比較[J].中醫(yī)正骨,2016,28(07):14-19.
　WANG Zhongfeng,WANG Xiao,LI Guojun,et al.Advancement of clinical application of vertebral bone graft material to treatment of thoracolumbar fractures[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2016,28(07):14-19.
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3種不同固定方式治療橈骨遠(yuǎn)端C型骨折的療效比較()
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《中醫(yī)正骨》[ISSN:1001-6015/CN:41-1162/R]

卷:
第28卷
期數(shù):
2016年07期
頁碼:
14-19
欄目:
臨床研究
出版日期:
2016-07-20

文章信息/Info

Title:
Advancement of clinical application of vertebral bone graft material to treatment of thoracolumbar fractures
作者:
王仲鋒; 王曉; 李國軍; 張淞; 劉洋
河南大學(xué)淮河醫(yī)院,河南 開封 475000
Author(s):
WANG Zhongfeng; WANG Xiao; LI Guojun; ZHANG Song; LIU Yang
Huaihe Hospital of Henan University,Kaifeng 475000,Henan,China
關(guān)鍵詞:
橈骨骨折;  橈腕關(guān)節(jié);  骨折固定術(shù)
Keywords:
radius fractures;  wrist joint;  fracture fixation
摘要:
目的:比較T形鎖定鋼板內(nèi)固定、T形鎖定鋼板內(nèi)固定聯(lián)合外固定架外固定及萬向雙柱鎖定鋼板內(nèi)固定治療橈骨遠(yuǎn)端C型骨折的臨床療效。方法:回顧性分析2008年1月至2015年1月手術(shù)治療的100例橈骨遠(yuǎn)端C型骨折患者的病例資料,男43例、女57例; 年齡20～75歲,中位數(shù)46歲,左側(cè)48例,右側(cè)52例。采用T形鎖定鋼板內(nèi)固定35例,采用T形鎖定鋼板內(nèi)固定聯(lián)合外固定架外固定33例,采用萬向雙柱鎖定鋼板內(nèi)固定32例。對(duì)比3組患者的骨折愈合情況、患肢腕關(guān)節(jié)活動(dòng)度(背伸、掌屈、橈偏、尺偏)、患側(cè)手握力、掌傾角、尺偏角、橈骨短縮長度及采用腕關(guān)節(jié)功能(patient-rated wrist evaluation,PRWE)評(píng)分標(biāo)準(zhǔn)評(píng)價(jià)的腕關(guān)節(jié)功能。結(jié)果:100例患者均獲隨訪,隨訪時(shí)間12～36個(gè)月,中位數(shù)24個(gè)月; 骨折均愈合,愈合時(shí)間12～22周,中位數(shù)16周。術(shù)后12個(gè)月,3組腕關(guān)節(jié)活動(dòng)度(背伸、掌屈、橈偏、尺偏)、患側(cè)手握力(占健側(cè)百分比)、掌傾角、尺偏角、橈骨短縮長度和PRWE評(píng)分的組間差異均有統(tǒng)計(jì)學(xué)意義[(58.3°±5.7°),(62.9°±6.6°),(63.6°±7.5°),F=6.299,P=0.003;(60.3°±6.8°),(68.1°±6.8°),(69.2°±7.7°),F=6.635,P=0.002;(16.3°±1.9°),(20.3°±2.4°),(19.8°±2.3°),F=34.365,P=0.000;(20.8°±2.7°),(23.4°±4.0°),(24.4°±2.6°),F=11.605,P=0.000;(70.4±2.7)%,(84.2±4.2)%,(84.3±4.3)%,F=65.652,P=0.000;(8.2°±1.8°),(9.9°±2.1°),(10.0°±1.8°),F=10.120,P=0.000;(13.7°±2.9°),(18.6°±3.6°),(19.8°±2.3°),F=40.137,P=0.000;(3.2±0.9)mm,(2.4±0.9)mm,(2.6±0.9)mm,F=7.516,P=0.000;(6.3±1.2)分,(8.0±0.9)分,(7.6±0.9)分,F=27.196,P=0.000]。與T形鎖定鋼板聯(lián)合外固定支架組和萬向雙柱鎖定鋼板組相比,T形鎖定鋼板組腕關(guān)節(jié)活動(dòng)度和患側(cè)手握力較差、掌傾角和尺偏角較小、橈骨短縮程度較大、PRWE評(píng)分均較低(P=0.005,P=0.007,P=0.000,P=0.001,P=0.000,P=0.000,P=0.000,P=0.000,P=0.000; P=0.002,P=0.001,P=0.000,P=0.000,P=0.000,P=0.000,P=0.000,P=0.000,P=0.006); 而萬向雙柱鎖定鋼板組與T形鎖定鋼板聯(lián)合外固定支架組比較,各指標(biāo)的組間差異均無統(tǒng)計(jì)學(xué)意義(P=0.691,P=0.513,P=0.401,P=0.202,P=0.922,P=0.114,P=0.897,P=0.105,P=0.388)。結(jié)論:與T形鎖定鋼板內(nèi)固定相比,T形鎖定鋼板內(nèi)固定聯(lián)合外固定架外固定和萬向雙柱鎖定鋼板內(nèi)固定治療橈骨遠(yuǎn)端C型骨折,能更好地維持骨折端的穩(wěn)定,更有利于腕關(guān)節(jié)功能的恢復(fù)。
Abstract:
Objective:To compare the clinical curative effects of T-shape locking plate internal fixation versus T-shape locking plate internal fixation combined with external fixator external fixation versus universal double rods locking plate internal fixation in treatment of type C distal radius fractures.Methods:The medical records of 100 patients with type C distal radius fractures who received surgery from January 2008 to January 2015 were analyzed retrospectively.The patients consisted of 43 males and 57 females,and ranged in age from 20 to 75 years(Median=46 yrs).The fractures located in left radius for 48 patients and right radius for 52 patients.Thirty-five patients were treated with T-shape locking plate internal fixation(group A),and 33 patients were treated with T-shape locking plate internal fixation combined with external fixator external fixation(group B),while 32 patients were treated with universal double rods locking plate internal fixation(group C).The fracture healing,range of motion(ROM)of wrist(dorsal expansion,palmar flexion,radial deviation and ulnar deviation),hand grip strength of affected side,volar tilt angles,radial inclination angles,radial shortening length and wrist function were compared between the 3 groups.The wrist function were evaluated by using patient-rated wrist evaluation(PRWE)scoring standard.Results:All patients in the 3 groups were followed up for 12-36 months with a median of 24 months and all fractures healed for 12-22 weeks with a median of 16 weeks.There was statistical difference in wrist ROM(dorsal expansion,palmar flexion,radial deviation and ulnar deviation),hand grip strength of affected side,volar tilt angles,radial inclination angles,radial shortening length and PRWE scores between the 3 groups at 12 months after surgery(58.3+/-5.7,62.9+/-6.6,63.6+/-7.5 degrees,F=6.299,P=0.003; 60.3+/-6.8,68.1+/-6.8,69.2+/-7.7 degrees,F=6.635,P=0.002; 16.3+/-1.9,20.3+/-2.4,19.8+/-2.3 degrees,F=34.365,P=0.000; 20.8+/-2.7,23.4+/-4.0,24.4+/-2.6 degrees,F=11.605,P=0.000; 70.4+/-2.7,84.2+/-4.2,84.3+/-4.3%,F=65.652,P=0.000; 8.2+/-1.8,9.9+/-2.1,10.0+/-1.8 degrees,F=10.120,P=0.000; 13.7+/-2.9,18.6+/-3.6,19.8+/-2.3 degrees,F=40.137,P=0.000; 3.2+/-0.9,2.4+/-0.9,2.6+/-0.9 mm,F=7.516,P=0.000; 6.3+/-1.2,8.0+/-0.9,7.6+/-0.9 points,F=27.196,P=0.000).The wrist ROM,hand grip strength of affected side,volar tilt angles and radial inclination angles were smaller,and the radial shortening degrees were larger and PRWE scores were lower in group A compared to group B and group C(P=0.005,P=0.007,P=0.000,P=0.001,P=0.000,P=0.000,P=0.000,P=0.000,P=0.000; P=0.002,P=0.001,P=0.000,P=0.000,P=0.000,P=0.000,P=0.000,P=0.000,P=0.006).There was no statistical difference in all indexs between group B and group C(P=0.691,P=0.513,P=0.401,P=0.202,P=0.922,P=0.114,P=0.897,P=0.105,P=0.388).Conclusion:T-shape locking plate internal fixation combined with external fixator external fixation and universal double rods locking plate internal fixation can better maintain the stability of broken ends of fractured bone and be more conducive to the recovery of wrist function compared to T-shape locking plate internal fixation in the treatment of type C distal radius fractures.

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備注/Memo

備注/Memo:
2016-04-29收稿 2016-06-05修回
王曉 E-mail:[email protected]

更新日期/Last Update: 1900-01-01