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中华老年骨科与康复电子杂志

中华老年骨科与康复电子杂志 ›› 2021, Vol. 07 ›› Issue (05) : 284 -290. doi: 10.3877/cma.j.issn.2096-0263.2021.05.006

上肢

掌背侧联合入路植骨钢板治疗老年C型桡骨远端骨折的疗效分析
林炳基1, 郭培义1, 张子宏1, 柯森淼1, 汪洋2,†()   
  1. 1. 528000　佛山复星禅城医院创伤骨外科
    2. 024000　赤峰市肿瘤医院骨一科
  • 收稿日期:2021-02-28 出版日期:2021-10-05
  • 通信作者: 汪洋
  • 基金资助:
    2019佛山市科技局(1920001000934)

Clinical study on the combined volar dorsal approach with bone graft and plate internal fixation for the treatment of elderly type C distal radius fractures

Bingji Lin1, Peiyi Guo1, Zihong Zhang1, Senmiao Ke1, Yang Wang2,†()   

  1. 1. Department of Orthopedics, Central Hospital of Chancheng District, FoShan 528000, China
    2. Department of Orthopedics, Chi Feng Cancer Hospital, Chi Feng 024000, China
  • Received:2021-02-28 Published:2021-10-05
  • Corresponding author: Yang Wang
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林炳基, 郭培义, 张子宏, 柯森淼, 汪洋. 掌背侧联合入路植骨钢板治疗老年C型桡骨远端骨折的疗效分析[J/OL]. 中华老年骨科与康复电子杂志, 2021, 07(05): 284-290.

Bingji Lin, Peiyi Guo, Zihong Zhang, Senmiao Ke, Yang Wang. Clinical study on the combined volar dorsal approach with bone graft and plate internal fixation for the treatment of elderly type C distal radius fractures[J/OL]. Chinese Journal of Geriatric Orthopaedics and Rehabilitation(Electronic Edition), 2021, 07(05): 284-290.

目的

探讨掌背侧联合入路植骨钢板内固定与外固定支架固定治疗AO C型老年性桡骨远端骨折的临床疗效分析。

方法

回顾性收集85例于2015年1月至2020年1月期间在佛山复星禅诚医院就诊的AO C型桡骨远端老年性骨质疏松性骨折患者，分为掌背侧联合入路切开复位钢板内固定组（ORIF）和闭合复位外固定架固定组（CREF），随访并比较两组患者手术时间、骨折愈合时间、住院天数、术后并发症、术后影像学情况、腕关节活动度、腕关节功能Garland-Werley评分。

结果

所有患者均获得随访，平均（15±4）个月。CREF组手术时间[（41±10）min]、骨折愈合时间[（9.2±2.7）w]、住院天数[（4.1±1.0）d]优于ORIF组[（72±9）min、（12.0±2.5）w、（7.4±1.2）d]，（P<0.05）。两组患者术后影像学比较中，ORIF组关节面塌陷程度[（0.7±1.3）mm]、掌倾角[（10.5±1.6）°]方面复位情况程度优于CREF组[（1.2±1.3）mm、（8.0±1.5）°]（P<0.05）。术后1年患者活动度功能均恢复良好，ORIF组的屈曲、背伸功能程度优于CREF组（P<0.05）。两组并发症发生率及术后1年Garland-Werley功能评分均无差异无统计学意（P>0.05）。

结论

掌背侧联合入路植骨钢板内固定与外固定架固定治疗AO C型老年性桡骨远端骨折均有良好的效果，但在患者术后腕关节活动度方面，掌背侧联合入路植骨钢板内固定更有优势。

关键词: 桡骨骨折, 老年人, 外固定, 骨折内固定
Objective

To investigate the clinical effect of combined volar dorsal approach bone graft plate internal fixation and external fixation in the treatment of of elderly type C distal radius fractures.

Methods

85 patients with AO C type distal radius osteoporotic fractures in our hospital from January 2015 to January 2020 were selected as the research objects. According to the different treatment methods, all the subjects were divided into two groups: open reduction and plate internal fixation group (ORIF) and closed reduction and external fixation group (CREF). The operation time, fracture healing time, hospital stay, postoperative complications, postoperative imaging, wrist range of motion and garland and werley score of wrist function were observed and compared between the two groups.

Results

All patients were followed up for an average of (15±4) months. The operation time of CREF group was (41±10)min, fracture healing time (9.2±2.7)w, hospitalization days (4.1±1.0)d was better than ORIF Group [(72±9)min, (12.0±2.5)w, (7.4±1.2)d], (P<0.05). In the comparison of postoperative imaging between two groups, the collapse degree of joint surface in ORIF group was (0.7±1.3)mm, palm inclination (10.5± 1.6)°. The degree of reduction was better than that of CREF Group [(1.2±1.3mm), (8.0±1.5)°](P<0.05). The mobility of patients recovered well in one year after operation, and the flexion and back extension of ORIF group were better than those in CREF group (P<0.05). There were no significant difference in the incidence of complications between the two groups and garland werley function score in 1 year after operation (P>0.05).

Conclusion

The combined volar dorsal approach with bone graft plate internal fixation and external fixation have good results in the treatment of AO C type elderly distal radius fractures, but in the aspect of postoperative wrist movement, the combined volar dorsal approach with bone graft plate internal fixation has more advantages.

Key words: Radius fractures, Aged, External fixation, Fracture fixation, internal
表1 CREF组与ORIF组老年C型桡骨远端骨折患者一般资料比较
组别 例数 年龄（岁，±s） 性别（例，男/女） 骨折分型（例） 合并糖尿病（例，有/无） 克氏辅助（例，有/无） 术前住院天数（d，±s） BMI指数(kg/m2)
C1 C2 C3
CREF组 45 65±5 21/24 20 16 9 24/21 10/35 1.2±0.5 23.8±2.4
ORIF组 40 65±5 18/22 18 15 7 22/18 15/25 1.5±0.4 23.6±2.6
统计值   t=0.731 χ2=0.024 χ2=0.094 χ2=0.024 χ2=2.387 t=1.856 t=0.635
P值   0.482 0.878 0.954 0.878 0.122 0.084 0.546
表2 CREF组与ORIF组老年C型桡骨远端骨折患者术后临床指标比较结果（±s）
组别 例数 手术时间（min，±s） 骨折愈合时间（w，±s） 住院天数（d，±s）
CREF组 45 41±10 9.2±2.7 4.1±1.0
ORIF组 40 72±9 12.0±2.5 7.4±1.2
t值   15.21 4.235 8.453
P值   0.001 0.001 0.001
表3 CREF组与ORIF组老年C型桡骨远端骨折患者术后影像学比较结果（±s）
组别 例数 掌倾角（°） 尺偏角（°） 关节塌陷（mm） 桡骨高度（mm）
CREF组 45 8.0±1.5 20.2±2.1 1.2±1.3 11.4±2.1
ORIF组 40 10.5±1.6 20.3±2.2 0.7±1.3 11.2±2.0
t值   3.834 0.121 5.857 0.574
P值   <0.001 0.909 <0.001 0.568
表4 CREF组与ORIF组老年C型桡骨远端骨折患者术后活动度比较结果（±s）
组别 例数 屈曲（°） 背伸（°） 桡倾（°） 尺倾（°） 腕关节功能评分
CREF组 45 50.7±3.3 50.6±5.1 17.5±3.2 24.3±3.4 4.6±1.3
ORIF组 40 58.8±3.9 60.6±5.2 17.2±3.4 23.4±3.8 4.2±1.3
t值   5.142 6.756 0.736 1.645 1.013
P值   0.001 0.001 0.493 0.104 0.205
图5~9 ORIF组，女性，78岁，右桡骨远端骨折，C1型，采用掌侧万向锁定板固定，背侧小切口复位同种异体骨植骨支撑。图5~6　术前正侧位；图7~8　术后第2天正侧位；图9　术中背侧小切口辅助复位植骨
表5 CREF组与ORIF组老年C型桡骨远端骨折患者术后并发症比较结果
组别 例数 腕关综合征 感染 再移位 创伤性关节炎 肌腱炎
CREF组 45 0 5 6 9 0
ORIF组 40 2 1 4 5 1
χ2值   2.304 2.629 0.228 0.879 1.521
P值   0.129 0.105 0.633 0.349 0.217
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