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Treatment of Unstable Fractures in Distal Radius: Internal Fixation or External Fixation
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摘要:
目的 回顾桡骨远端不稳定骨折行切开复位内固定和闭合复位外固定治疗的临床效果。 方法 2005年9月至2008年2月本科同一术者收治的桡骨远端不稳定骨折患者共44例, 平均年龄61.5岁; 按照AO分型, A型11例, B型9例, C型24例。外固定(external fixation, EF)21例, 切开复位内固定(open reduction and internal fixation, ORIF)23例, EF组行闭合复位、跨腕关节外固定架固定, ORIF组行切开复位、掌侧钢板内固定。手术均由同一术者完成, 记录手术时间、出血量。术后3个月、1年、2年随访, 测量桡骨长度、尺偏角和掌倾角, 评估Gartland-Wertley(GW)腕关节评分、腕关节活动度和握力。记录所有并发症。 结果 术后3个月44例患者均获随访, 1和2年获得随访患者分别为40和36例。ORIF组有愈合延迟1例, 螺钉断裂1例; EF组有愈合延迟1例, 针道感染1例。EF组手术时间、出血量小于ORIF组。术后3个月随访, ORIF组GW评分、腕关节掌屈活动度、背伸活动度和握力均好于EF组; 1年随访, ORIF组腕关节掌屈活动度和握力好于EF组; 2年随访, ORIF组腕关节掌屈活动度好于EF组。影像学指标两组无明显差异。 结论 对于桡骨远端不稳定骨折, 外固定手术创伤较小, 而内固定术后2年内临床效果更好。 Abstract:Objective To evaluate the clinical results of open reduction and internal fixation(ORIF) and external fixation(EF)for the treatment of unstable fractures in distal radius. Methods From September 2005 to February 2008, 44 patients(average age:61.5 years) with unstable distal radial fractures were treated in our department by the same surgeon with either ORIF or EF. According to AO Muller classification, there were 11 cases of type A, 9 cases of type B, and 24 cases of type C. Twenty-one cases were treated with EF, while 23 cases with ORIF. The duration of operation and intra-operative blood loss were recorded. The patients were followed up 3 months, 1 year, and 2 years after surgery. Clinical and radiological outcomes, including Gartland-Wertley(GW) scores, range of motion of wrist joint, and grip strength, were measured. Complications were observed and recorded. Results EF took shorter time and less blood loss than ORIF. At the 3-month follow-up, ORIF cases showed superior GW scores, volar flexion, dorsiflexion and grip strength than EF. At the 1-year follow-up, better volar flexion and grip strength were found in ORIF cases. At the 2-year follow-up, ORIF cases still showed better volar flexion than EF. Conclusion In the treatment of unstable distal radial fractures, ORIF can achieve better clinical outcomes in the first 2 years, while EF offers shorter operation time and less blood loss. -
Key words:
- distal radial fracture /
- unstable fracture /
- internal fixation /
- external fixation
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表 1 术后3个月随访结果
表 2 术后1年随访结果
表 3 术后2年随访结果
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[1] Jupiter JB.Current concepts reviews:fractures of distal end of the radius[J].J Bone Joint Surg, 1991, 73A:461-469. http://ci.nii.ac.jp/naid/10011196111 [2] Baratz ME, Des Jardins J, Anderson JJ, et al.Displaced intra-articular fracture of the distal radius:the effect of fracture displacement on contact stresses in a cadaver model[J].J Hand Surg, 1996, 21:183-188. doi: 10.1016/S0363-5023(96)80098-0 [3] Harish K, Agurual A, Dhaon BK.Displaced intra-articular fractures of distal radius:a comparative evaluation of results following closed reduction with internal fixation[J].Injury, 2000, 31:75. doi: 10.1016/S0020-1383(99)00207-7 [4] Handoll HH, Madhok R.Surgical interventions for treating distal radial fractures in adults[J/OL].Cochrane Database Syst Rev.2003b.CD003209.http://www.researchgate.net/journal/1469-493x-Cochranl-database-of-systematic-reviews-online. [5] Margaliot Z, Haase SC, Kotsis SV, et al.A meta-analysis of outcomes of external fixation versus plate osteosynthesis for unstable distal radius fractures[J].J Hand Surg, 2005, 30:1185-1199. http://so.med.wanfangdata.com.cn/ViewHTML/PeriodicalPaper_JJ021232963.aspx [6] Grewal R, Perey B, Wilmink M, et al.A randomized prospective study on the treatment of intra-articular distal radius fractures:open reduction and internal fixation with dorsal plating versus mini open reduction, percutaneous fixation, and external fixation[J].J Hand Surg, 2005, 30:764-772. doi: 10.1016/j.jhsa.2005.04.019 [7] Kreder HJ, Hanel DP, Agel J, et al.Indirect reduction and percutaneous fixation versus open reduction and internal fixation for displaced intra-articularfractures of the distal radius:a randomised, controlled trial[J].J Bone Joint Surg, 2005, 87:829-836. http://europepmc.org/abstract/med/15911668 [8] Leung F, Tu YK, Chew WY, et al.Comparison of external and percutaneous pin fixation with plate fixation for intra-articular distal radial fractures.A randomized study[J].J Bone Joint Surg, 2008, 90:16-22. doi: 10.2106/JBJS.F.01581 [9] Abramo A, Kopylov P, Geijer M, et al.Open reduction and internal fixation compared to closed reduction and external fixation in distal radial fractures:a randomized study of 50 patients[J].Acta Orthop, 2009, 80:478-485. doi: 10.3109/17453670903171875 [10] Jupiter JB, Marent-Huber M.Operative management of distal radial fractures with 2.4-millimeter locking plates.A multicenter prospective case series[J].J Bone Joint Surg Am, 2009, 91:55-65. http://www.ncbi.nlm.nih.gov/pubmed/17419673 [11] Gruber G, Gruber K, Giessauf C, et al.Volar plate fixation of AOtype C2 and C3 distal radius fractures, a single-center study of 55 patients[J].J Orthop Trauma, 2008, 22:467-472. doi: 10.1097/BOT.0b013e318180db09 -
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