桡骨远端骨折内固定与外固定的比较

Internal fixation with volar locking plate versus external fixator combined with percutaneous Kirshner wire for unstable dis⁃ tal radius fractures

摘要:

［目的］ 比较掌侧锁定钢板 （volar locking plate, VLP） 与外固定架联合经皮克氏针固定不稳定性桡骨远端骨折 （un- stable distal radius fractures, UDRF）的临床疗效。［方法］回顾性分析 2018 年 1 月—2020 年 1 月本院手术收治的 73 例 UDRF 患者的临床资料。依据术前医患沟通结果，41 例采用 VLP 内固定 （内固定组），32 例采用外固定架联合经皮克氏针固定 （外固定组）。比较两组围手术期、随访期及影像学资料。［结果］两组均顺利完成手术，虽然内固定组手术时间显著长于外固定组， 但术中透视次数、早期 VAS 评分均显著优于外固定组 （P<0.05）。术后并发症总发生率内固定组为 7.3%，外固定组为 25.0%， 差异有统计学意义 （P<0.05）。平均随访 （15.3±2.1） 个月，内固定组恢复完全负重活动时间显著早于外固定组 （P<0.05）。术后内固定组 Cooney 评分、腕掌屈-背伸 ROM、腕尺偏-桡偏 ROM、前臂旋前-旋后 ROM 均优于外固定组 （P<0.05）。影像方面，术后即刻和末次随访时，内固定组的 PT、RI、RL 和关节面对合分级均显著优于外固定组 （P<0.05）。影像显示内固定组骨折愈合时间显著早于外固定组（P<0.05）。［结论］与外固定架联合克氏针外固定相比，VLP 内固定早期不良反应轻，功能恢复好，更有利于骨折愈合。

Abstract:

[Objective] To compare the clinical outcomes of internal fixation with volar locking plate (VLP) versus external fixator com- bined with percutaneous Kirshner wire for unstable distal radius fractures (UDRF) . [Methods] A retrospective study was performed on 73 patients who underwent surgical treatment for UDRF in our hospital from January 2018 to January 2020. According to the results of preoper- ative doctor-patient communication, 41 patients received VLP internal fixation (the IF group) , while the remaining 32 patients were treated with external fixator combined with percutaneous Kirshner wire (the EF group) . The perioperative, follow-up and imaging data were com- pared between the two groups. [Results] All the patients in both groups had operation performed smoothly. Although the IF group consumed significantly longer operation time than the EF group (P＜0.05) , the former proved significantly superior to the latter in terms of times of in- traoperative fluoroscopy and VAS scores in the early stage (P＜0.05) . The total incidence of postoperative complications was 7.3% in the IF group, whereas 25.0% in the EF group, which was statistically significant (P＜0.05) . All patients in both groups were followed up for (15.3± 2.1) months on an average, and the IF group returned to full weight-bearing activity significantly earlier than the EF group (P＜0.05) . In ad- dition, the IF group proved considerably superior to the EF group in terms of Cooney score, flexion-dorsiflexion range of motion (ROM) , ul- nar-radial deviation ROM, and forearm pronation/supination ROM postoperatively (P＜0.05) . Radiographically, the IF group proved signifi- cantly superior to the EF group in terms of palmar tilt (PT) , radial inclination (RI) , radial length (RL) , and joint congruence grade immedi- ately after surgery and at last follow-up (P＜0.05) , moreover, the former got fracture healing on images significantly earlier than the latter (P＜0.05) . [Conclusion] Compared with external fixator combined with Kirschner wire, the VLP internal fixation has fewer early adverse re- actions, better functional recovery, and is more conducive to fracture healing.