| 摘要: |
| 目的 比较经皮双外固定架（EF）与EF联合掌侧接骨板（VLP）治疗AO C1、C2和C3型桡骨远端骨折的疗效。方法 回顾2019－2022年108例AO C型桡骨远端骨折患者的资料，其中51例患者采用双EF（无桥接骨水泥克氏针框架和传统跨腕EF）治疗，57例患者采用传统跨腕EF联合VLP治疗。测量两组患者的影像学参数（桡骨掌倾角、桡骨尺偏角、桡骨茎突高度、尺骨变异等）、腕关节活动度及握力，采用视觉模拟量表（VAS）评估腕部疼痛强度，通过上肢功能障碍评定量表（DASH）评估上肢的整体功能，通过Mayo腕关节评分系统（MWS）评估腕关节功能，采用患者满意度短期评估量表（SAPS）评估患者满意度。根据患者主诉及外科医师的综合判断评估患者的并发症发生情况。结果 两组患者在年龄、性别、致伤原因、AO分型及手术时间方面差异均无统计学意义（均P＞0.05）；双EF组在手术等待时间、术中出血量、住院天数方面均优于EF联合VLP组（均P＜0.001）。术后随访24～33个月。末次随访时，两组患者桡骨掌倾角、桡骨尺偏角、桡骨茎突高度、尺骨变异差异均无统计学意义（均P＞0.05）。末次随访时，双EF组在VAS疼痛评分及SAPS患者满意度评分方面均优于EF联合VLP组（P＝0.025、0.015），两组间腕关节活动范围（屈曲、背伸、桡偏、尺偏、旋前、旋后）、握力及MWS、DASH评分差异均无统计学意义（均P＞0.05）。双EF组总体并发症发生率为13.73%（7/51），低于EF联合VLP组的28.07%（16/57）（P＜0.05）。结论 经皮双EF技术操作简单、安全、并发症少、随访效果满意，可作为OA C型桡骨远端骨折的一种治疗选择。 |
| 关键词: 桡骨远端骨折 外固定架 掌侧接骨板 腕关节功能 经皮 |
| DOI：10.16781/j.CN31-2187/R.20230695 |
| 投稿时间：2023-12-04修订日期：2024-01-18 |
| 基金项目:河北省医学科学研究课题（20240942）. |
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| Percutaneous double external fixators and external fixator combined with locking plate in the treatment of AO C-type distal radius fractures: a comparative study |
| YU Xiaofei1,LI Nan2,YU Yadong1,SHAO Xinzhong1,WANG Li1,ZHANG Xu1* |
(1. Department of Hand Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang 050051, Hebei, China;
2. Department of Neuromuscular Diseases, The Third Hospital of Hebei Medical University, Shijiazhuang 050051, Hebei, China
* Corresponding author) |
| Abstract: |
| Objective To compare the efficacy of percutaneous double external fixators (EF) and EF combined with volar locking plate (VLP) in the treatment of AO C1, C2 and C3 type distal radius fracture (DRF). Methods The data of 108 patients with AO C-type DRF from 2019 to 2022 were reviewed. Fifty-one patients were treated with double EF (a no-bridging cemented-pin frame and a conventional wrist-bridging EF) and 57 patients were treated with EF (a conventional wrist-bridging EF) combined with VLP. The imaging parameters (palmar tilt, radial inclination, radial height, ulnar variance, etc.), wrist motion and grip strength were measured. Wrist pain intensity was evaluated by visual analogue scale (VAS). The whole function of the upper limb was assessed by disability of arm shoulder and hand scale (DASH), the wrist function was evaluated by Mayo wrist score (MWS), and the patient satisfaction was evaluated by short assessment of patient satisfaction (SAPS). The incidence of complications was evaluated according to the patient’s chief complaint and the surgeon’s comprehensive judgement. Results There were no significant differences in age, gender, injury cause, AO types or operation time between the 2 groups (all P＞0.05). The time from injury to operation, intraoperative blood loss and hospital stay in the double EF group were superior to those in the EF combined with VLP group (all P＜0.001). The patients were followed up for 24 to 33 months. There were no significant differences in palmar tilt, radial inclination, radial height or ulnar variance at the last follow-up (all P＞0.05); the VAS score (P＝0.025) and SAPS score (P＝0.015) in the double EF group were significantly better than those in the EF combined with VLP group. There were no significant differences in the range of motion (flexion, extension, radial deviation, ulnar deviation, pronation or supination), grip strength, MWS or DASH scores between the 2 groups (all P＞0.05). The overall complication rate of the double EF group was 13.73% (7/51), which was lower than that of the EF combined with VLP group (28.07%) (16/57) (P＜0.05). Conclusion Percutaneous double EF is easy to operate and relatively safe, with few complications and satisfactory follow-up results. It can be a treatment option for OA C-type DRF. |
| Key words: distal radius fractures external fixator volar locking plate wrist function percutaneous |
