C型桡骨远端骨折患者腕关节功能及骨折复位质量:克氏针辅助外固定架、外固定架及掌侧入路钢板内固定的比较
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摘要
背景:C型桡骨远端骨折不同固定术式的康复进程、腕关节功能以及骨折复位质量各不相同,不同固定术式之间的对比仍缺乏足够的证据,尚存在一些争议。目的:探讨克氏针辅助外固定架、外固定架及掌侧入路钢板内固定对C型桡骨远端骨折患者康复进程、腕关节功能以及骨折复位质量的影响。方法:回顾性分析2016年1月至2017年12月海南省人民医院收治的C型桡骨远端骨折患者的临床资料,93例患者完成随访,根据固定方案分为3组,其中克氏针辅助外固定架组32例,外固定架组21例,钢板内固定组40例接受掌侧入路钢板内固定治疗。所有患者对治疗方案均知情同意,且得到医院伦理委员会批准。对比分析3组患者的临床手术指标、康复进程、腕关节功能优良率以及骨折复位质量,并记录患者满意度及并发症发生情况。结果与结论:(1)克氏针辅助外固定架组、外固定架组的手术时间、住院时间、骨折愈合时间均短于钢板内固定组(F=200.589,100.379,14.282,P均<0.05);(2)术后6个月,钢板内固定组的腕关节功能优良率高于克氏针辅助外固定架组和外固定架组(χ~2=6.541,P <0.05);(3)术后12个月,钢板内固定组的掌倾角、尺偏角均大于克氏针辅助外固定架组和外固定架组(F=87.622,33.077,P均<0.05);(4)克氏针辅助外固定架组、外固定架组的并发症发生率低于钢板内固定组(χ~2=6.455,P <0.05);(5)结果表明,3种固定术式治疗C型桡骨远端骨折的临床疗效均较满意,其中克氏针辅助外固定架、外固定架具有手术时间短、愈合时间短、并发症发生率低的优势;克氏针辅助外固定架的骨折复位质量优于外固定架;掌侧入路钢板内固定术后早期优良率高,且骨折复位质量高。
BACKGROUND: The recovery process, wrist join function and resetting quality of different fixation methods for type C distal radial fractures are different. The comparisons among different fixation methods are lack of sufficient evidence, and there is still some controversy. OBJECTIVE: To investigate the effects of Kirschner wire external fixator, external fixator and volar approach plate internal fixation on the recovery process, wrist join function and resetting quality of type C distal radius fractures patients. METHODS: The clinical data of type C distal radius fracture patients who were treated in Hainan Provincial People's Hospital from January 2016 to December 2017 were retrospectively analyzed. Totally 93 patients were followed up. Among them, 32 patients underwent Kirschner wire external fixator fixation(Kirschner wire external fixator group), 21 patients underwent external fixator fixation(external fixator group), and 40 patients underwent volar approach plate internal fixation(volar approach plate internal fixation group). All patients signed informed consent. This study was approved by the Hospital Ethics Committee. The clinical operation indexes, recovery process, excellent and good rate of wrist joint function and fracture reduction quality of the three groups were compared and analyzed. The patients' satisfaction and complications were recorded. RESULTS AND CONCLUSION:(1) The operation time, hospitalization time and fracture healing time of Kirschner wire external fixator group and external fixator group were shorter than those of volar approach plate internal group(F=200.589, 100.379, 14.282, all P < 0.05).(2) At 6 months after operation, the excellent and good rate of wrist joint in volar approach plate fixation group was higher than that in Kirschner wire external fixator group and external fixator group(χ~2=6.541, P < 0.05).(3) At 12 months after operation, the palmar inclination and ulnar deviation of the volar approach plate internal fixation group were greater than those of the Kirschner wire external fixator group and external fixator group(F=87.622, 33.077, all P < 0.05).(4) The incidence of complications in Kirschner wire external fixator group and external fixator group was lower than that in volar approach plate internal fixation group(χ~2=6.455, P < 0.05).(5) Results suggested that the clinical effects of three fixation methods for patients with type C distal radius fractures are satisfactory. Among them, the Kirschner wire external fixator and external fixator have the advantages of shorter operation time, shorter quicker healing, and lower incidence of complications. The resetting quality of the Kirschner wire external fixator is better than that of external fixator. While the volar approach plate internal fixation owns higher early good rate and better resetting quality.
BACKGROUND: The recovery process, wrist join function and resetting quality of different fixation methods for type C distal radial fractures are different. The comparisons among different fixation methods are lack of sufficient evidence, and there is still some controversy. OBJECTIVE: To investigate the effects of Kirschner wire external fixator, external fixator and volar approach plate internal fixation on the recovery process, wrist join function and resetting quality of type C distal radius fractures patients. METHODS: The clinical data of type C distal radius fracture patients who were treated in Hainan Provincial People's Hospital from January 2016 to December 2017 were retrospectively analyzed. Totally 93 patients were followed up. Among them, 32 patients underwent Kirschner wire external fixator fixation(Kirschner wire external fixator group), 21 patients underwent external fixator fixation(external fixator group), and 40 patients underwent volar approach plate internal fixation(volar approach plate internal fixation group). All patients signed informed consent. This study was approved by the Hospital Ethics Committee. The clinical operation indexes, recovery process, excellent and good rate of wrist joint function and fracture reduction quality of the three groups were compared and analyzed. The patients' satisfaction and complications were recorded. RESULTS AND CONCLUSION:(1) The operation time, hospitalization time and fracture healing time of Kirschner wire external fixator group and external fixator group were shorter than those of volar approach plate internal group(F=200.589, 100.379, 14.282, all P < 0.05).(2) At 6 months after operation, the excellent and good rate of wrist joint in volar approach plate fixation group was higher than that in Kirschner wire external fixator group and external fixator group(χ~2=6.541, P < 0.05).(3) At 12 months after operation, the palmar inclination and ulnar deviation of the volar approach plate internal fixation group were greater than those of the Kirschner wire external fixator group and external fixator group(F=87.622, 33.077, all P < 0.05).(4) The incidence of complications in Kirschner wire external fixator group and external fixator group was lower than that in volar approach plate internal fixation group(χ~2=6.455, P < 0.05).(5) Results suggested that the clinical effects of three fixation methods for patients with type C distal radius fractures are satisfactory. Among them, the Kirschner wire external fixator and external fixator have the advantages of shorter operation time, shorter quicker healing, and lower incidence of complications. The resetting quality of the Kirschner wire external fixator is better than that of external fixator. While the volar approach plate internal fixation owns higher early good rate and better resetting quality.
引文
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[25]Wang J,Lu Y,Cui Y,et al.Is volar locking plate superior to external fixation for distal radius fractures?A comprehensive meta-analysis.Acta Orthop Traumatol Turc.2018;52(5):334-342.
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[2]Heidgerd R,Morgan J,Schentrup D.Evaluation of functional outcomes for adult patients after distal radius fracture treated with volar plate fixation versus nonsurgical care.J Trauma Nurs.2019;26(1):59-64.
[3]吴文侠,李建林,李铁军,等.万向锁定加压钢板与克氏针结合外固定支架对老年绝经期骨质疏松性桡骨远端C型骨折短缩程度及关节功能的影响[J].医学临床研究,2015,32(3):549-551.
[4]Bartl C,Stengel D,Bruckner T,et al.The treatment of displaced intra-articular distal radius fractures in elderly patients.Dtsch Arztebl Int.2014;111(46):779-787.
[5]Lang PO,Bickel KD.Distal radius fractures:percutaneous treatment versus open reduction with internal fixation.J Hand Surg Am.2014;39(3):546-548.
[6]胥少汀.实用骨科学[M].4版.北京:人民军医出版社,2012:316-318.
[7]刘长发,汪少春,姚亮,等.克氏针辅助外固定架与掌侧入路钢板内固定治疗AOC型桡骨远端骨折的疗效比较[J].中国骨与关节损伤杂志,2016,31(7):770-771.
[8]张胜华.克氏针加强外固定架与锁定加压钢板治疗桡骨远端C3型骨折的对比性研究[J].中国煤炭工业医学杂志,2016,19(6):856-859.
[9]Guo W,Yuan B,Zhu Z,et al.Non-dislocation lunate fracture combined with distal radius fracture:A case report.Medicine(Baltimore).2018;97(49):e13574.
[10]蔡振存,赵群,张立军.外固定架结合有限克氏针微创治疗桡骨远端C型骨折的临床研究[J].中国医科大学学报,2014,43(12):1145-1146.
[11]姜新华,禹宝庆,王永安,等.掌侧柱锁定接骨板治疗桡骨远端C型骨折的疗效分析[J].中华骨与关节外科杂志,2015,8(2):157-160.
[12]Ibrahim T,OMS A,Hegazy A,et al.Applicability of the AAOSappropriate-use criteria for distal radius fractures in surgical practice.Int Orthop.2018;42(1):197-202.
[13]Kyriakedes JC,Tsai EY,Weinberg DS,et al.Distal radius fractures:aaos appropriate use criteria versus actual management at a level i trauma center.Hand(NY).2018;13(2):209-214.
[14]王古衡,谢仁国,茅天,等.C型桡骨远端骨折掌侧内固定中接骨板不同位置对疗效影响[J].中华手外科杂志,2016,32(2):116-119.
[15]富玲,辛畅泰,王英博,等.桡骨远端C型骨折行外固定支架与锁定钢板内固定的差异分析[J].现代生物医学进展,2017,17(33):6531-6535.
[16]朱成栋,朱乐银,乔高山,等.跨腕关节外固定支架配合克氏针治疗桡骨远端C型骨折的疗效分析[J].生物骨科材料与临床研究,2015,12(1):55-58.
[17]王松,刘孟军,杨青山,等.克氏针与钢板置入内固定修复老年桡骨远端骨折安全及有效性的Meta分析[J].中国组织工程研究,2016,20(9):1361-1368.
[18]Duramaz A,Bilgili MG,Karaali E,et al.Volar locking plate versus K-wire-supported external fixation in the treatment of AO/ASIF type C distal radius fractures:A comparison of functional and radiological outcomes.Ulus Travma Acil Cerrahi Derg.2018;24(3):255-262.
[19]赵继军,吴沼锋,王陵,等.桡骨远端T型锁定接骨板治疗老年桡骨远端不稳定性骨折的疗效[J].中国老年学杂志,2015,35(22):6584-6585.
[20]蔺广生.经皮克氏针内固定与掌锁定钢板内固定治疗成人桡骨远端背侧移位骨折临床疗效比较[J].临床和实验医学杂志,2016,15(17):1708-1711.
[21]王东建,张鑫,张延栋.克氏针经皮固定治疗桡骨远端骨折[J].临床骨科杂志,2017,20(1):80-81.
[22]蔡浩.克氏针外固定结合钢板内固定治疗桡骨远端粉碎性骨折的疗效分析[J].中国伤残医学,2018,26(2):45-46.
[23]王涛,刘剑,张文生,等.克氏针结合可调式外固定架治疗桡骨远端骨折32例[J].陕西医学杂志,2014,43(1):90-91,92.
[24]王荣林,肖毅.锁定加压钢板+经皮克氏针治疗桡骨远端粉碎性骨折的疗效[J].实用中西医结合临床,2018,18(4):137-138.
[25]Wang J,Lu Y,Cui Y,et al.Is volar locking plate superior to external fixation for distal radius fractures?A comprehensive meta-analysis.Acta Orthop Traumatol Turc.2018;52(5):334-342.
[26]朱乘春.掌侧入路切开复位钢板内固定与闭合复位外固定支架治疗桡骨远端骨折患者的效果[J].医疗装备,2018,31(12):117-118.
[27]张树峰,叶武智,高长城,等.切开复位钢板内固定与闭合复位外支架固定治疗老年桡骨远端C型骨折疗效比较[J].陕西医学杂志,2015,44(11):1504-1505.
[28]余荣煌,林石明.闭合复位外支架结合克氏针治疗桡骨远端不稳定性骨折的临床研究[J].医药前沿,2015,5(31):160-161.
[29]李家德,钟永翔,陈榆,等.外固定架结合克氏针有限固定与掌侧锁定板治疗桡骨远端粉碎骨折的疗效对比[J].中华手外科杂志,2018,34(3):185-188.
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