万向掌侧双柱LCP联合克氏针与外固定架治疗C型桡骨远端骨折疗效对比

发布时间：2018-05-04 12:19

本文选题：桡骨骨折 + 锁定加压钢板　；参考：《山东大学》2016年硕士论文

【摘要】：目的通过对万向掌侧双柱LCP联合克氏针与外固定架结合克氏针治疗AO/ASIFC型桡骨远端骨折的临床效果对比分析,比较两种方式优缺点,探讨AO/ASIF C型桡骨远端骨折的治疗策略并为临床治疗提供指导。方法收集2012年1月至2015年1月期间在我院创伤骨科进行治疗的51例AO/ASIF C型桡骨远端骨折患者临床资料,纳入本研究并获得长期随访满意者34例,其中经万向掌侧双柱LCP联合克氏针治疗组20例,年龄31～68岁,平均(53.06±8.70)岁,按照AO/ASIF分型,其中C1型6例、C2型11例、C3型3例；超腕外固定架有限切口克氏针固定治疗组14例,年龄28～70岁,平均(52.20±10.89)岁,按照AO/ASIF分型,其中C1型4例、C2型4例、C3型6例。两组均为新鲜闭合性骨折。两组骨缺损严重的病例均行植骨治疗,术后常规康复治疗。术后随访,比较两组患者腕关节掌屈、背伸、桡偏、尺偏、旋前、旋后等各向活动度及掌倾角、尺偏角、桡骨茎突高度、关节面平整度等相关影像学资料,根据腕关节Gartland-Werley评分评估术后腕关节功能情况,改良Sarmiento评估影像学情况。结果所有患者均获得随访,随访时间万向掌侧双柱LCP联合克氏针组12～36个月,平均(23.01±7.24)个月,超腕外固定架结合克氏针组12～40个月,平均(22.28±6.62)个月。愈合时间万向掌侧双柱LCP联合克氏针组平均(10.97±1.37)周,超腕外固定架结合克氏针组平均(11.48±1.64)周,无明显统计学差异(P0.05)；两组去除克氏针平均时间6周。7例植骨患者愈合良好。两组患者尺偏角、桡骨茎突高度、腕关节Gartland-Werley评分、腕关节桡偏、尺偏、旋前、旋后活动均无显著性差异。万向掌侧双柱LCP联合克氏针组掌倾角10.48°±1.48°,超腕外固定架结合克氏针组掌倾角4.94°±2.30°,万向掌侧双柱LCP联合克氏针组优于外固定组,两者差异具统计学意义(P0.05)；万向掌侧双柱LCP联合克氏针组关节面台阶(0.60±0.29)mm,外固定架组关节面台阶(1.50±0.24)mm,万向掌侧双柱LCP联合克氏针组优于外固定架组,两者差异具统计学意义(P0.05)；万向掌侧双柱LCP联合克氏针组改良Sarmiento评分(2.14±1.07)分,外固定架组改良Sarmiento评分(4.28±2.65)分,万向掌侧双柱LCP联合克氏针组优于外固定组,两者差异具统计学意义(P0.05);万向掌侧双柱LCP联合克氏针组掌屈64.88°-8.54°,外固定架组掌屈58.41°±5.52°,万向掌侧双柱LCP联合克氏针组优于外固定组,两者差异具统计学意义(P0.05)；万向掌侧双柱LCP联合克氏针组背伸66.22°±7.02°,外固定架组背伸60.88°±8.54°,万向掌侧双柱LCP联合克氏针组优于外固定组,两者差异具统计学意义(P0.05)。末次随访根据腕关节Gartland-Werley评分：万向掌侧双柱LCP联合克氏针组优11例,良6例,可3例,优良率85.0%,超腕外固定架结合克氏针组优6例,良5例,可2例,差1例,优良率78.6%；依照改良Sarmiento评分标准：万向掌侧双柱LCP联合克氏针组优6例,良10例,可4例,优良率80.0%,超腕外固定架结合克氏针组优2例,良8例,可2例,差2例,优良率71.4%。并发症情况：万向掌侧双柱LCP联合克氏针组拇长伸肌腱断裂1例,复杂区域疼痛综合征1例,固定松动1例；外固定架组肌腱激惹1例,创伤性关节炎1例,固定松动1例,针道感染2例。结论两种治疗方式治疗AO/ASIF C型桡骨远端骨折均可达较满意临床疗效。万向掌侧双柱LCP联合克氏针治疗组整体疗效稍优于外固定架结合克氏针治疗组,在恢复掌倾角、关节面平整度,腕关节掌屈、背伸活动方面优于后者；其余影像学指标及腕关节活动度二者无显著差异。万向掌侧双柱LCP联合克氏针可达较满意复位并有效维持复位,术后早期功能锻炼,并发症较少,腕关节功能结果较满意,是治疗AO/ASIF C型桡骨远端骨折可供选择的方法。临床可依据患者情况合理选择治疗方式。术中植骨纠正骨缺损可辅助维持内植物的有效支撑及促进骨折愈合。
[Abstract]:Objective to compare the clinical effects of the LCP combined Kirschner pin combined with Kirschner pin with the external fixator and Kirschner pin for the treatment of AO/ASIFC type distal radius fractures, and compare the advantages and disadvantages of the two methods, and discuss the treatment strategy of the AO/ASIF C type distal radius fracture and provide guidance for clinical treatment. Methods collect the period from January 2012 to January 2015. The clinical data of 51 cases of AO/ASIF C distal radius fracture treated in our hospital trauma department of orthopedics were included in this study and 34 cases were satisfied with long-term follow-up, of which 20 cases were treated by universal palmar double column LCP combined with Kirschner needle, age 31~68 years old, with an average of (53.06 + 8.70) years, in which 6 cases of C1, 11 cases of C2, 3 cases of C3 type. 14 cases of Kirschner needle fixation in the limited incision of the external fixator were 28~70 years old, with an average age of (52.20 + 10.89) years old, according to the AO/ASIF typing, among which 4 cases were C1, 4 C2, 6 of C3. All cases of severe bone defect were treated with bone graft and routine rehabilitation after operation. Two groups of patients were followed up after operation, two groups were compared. Wrist joint flexion, dorsal extension, radial deviation, ulnar deviation, pronation, rotation and other isotropic activity and palmar angle, ulnar angle, height of the styloid process of the radius, joint surface evenness and other related imaging data. The wrist joint function was evaluated according to Gartland-Werley score of wrist joint, and Sarmiento was improved to evaluate imaging. All patients were followed up. All patients were followed up, followed up, follow up, follow up, follow up, follow up, follow up with all patients, follow up, follow up LCP combined Kirschner's needle group for 12~36 months, the average (23.01 + 7.24) months, the extra wrist external fixator combined with Kirschner's needle group for 12~40 months, averaging (22.28 + 6.62) months. The average healing time was (10.97 + 1.37) weeks (10.97 + 1.37) weeks, and the extra wrist external fixator combined with Kirschner's needle group was (11.48 + 1.64) weeks). There was no significant difference in Statistics (P0.05); two groups of patients with Kirschner's average time of 6 weeks were healed well. The two groups had no significant difference between the ulnar angle, the height of the styloid process of the radius, the wrist joint Gartland-Werley score, the wrist joint radial deviation, the ulnar deviation, the pronation and the rotation, and the volar side double column LCP combined with the Kirschner group's palmar angle of 10.48? 1.48. In combination with Kirschner's acupuncture group and Kirschner's needle group, the palmar angle was 4.94 and 2.30 degrees, and the LCP combined Kirschner pin group was superior to the external fixation group. The difference was statistically significant (P0.05); the joint surface steps (0.60 + 0.29) mm of the universal palmar double column LCP combined with Kirschner needle, the joint surface steps (1.50 + 0.24) mm in the external fixator group and the universal palmar double column LCP The group of Kirschner's needle group was better than the external fixator (P0.05), and the modified Sarmiento score (2.14 + 1.07) of the LCP combined with Kirschner needle in the cardan side double column group and the improved Sarmiento score of the external fixator group (4.28 + 2.65), and the universal palmar double column LCP combined Kirschner group were superior to those in the external fixation group, and the difference was statistically significant (P0.05 The volar side double column LCP combined with Kirschner's hand flexion 64.88 degrees -8.54 degrees, the external fixator group palmar flexion 58.41 + 5.52 degrees, the universal palmar double column LCP Kirschner group is superior to the external fixation group, the difference has statistical significance (P0.05), the cardan side double column LCP combined Kirschner group's back extension 66.22? 7.02 degrees, the external fixator's back extension 60.88? 8.54 [8.54], 10000 The two column LCP combined with Kirschner needle group was superior to the external fixation group (P0.05). The last follow-up was based on the wrist joint Gartland-Werley score: 11 cases of universal palmar double column LCP combined with Kirschner needle, good in 3 cases, good rate 85%, superior wrist external fixator combined with Kirschner needle, good in 6 cases, good 5 cases, 2 cases, and poor 1 cases. Rate 78.6%, according to the improved Sarmiento score standard: 6 cases of universal palmar double column combined with Kirschner needle, good 10 cases, 4 cases, good rate 80%, excellent 2 cases of super wrist external fixator combined with Kirschner needle, 8 good cases, 2 cases, 2 poor cases, and good rate of 71.4%. complications: 1 cases, complex and complex fracture of hallux extensor tendon of universal palm side double column LCP combined Kirschner needle group, complex and complex 1 cases of regional pain syndrome, 1 cases of fixed loosening, 1 cases of tendon irritation in external fixator group, 1 cases of traumatic arthritis, 1 cases of fixed loosening, 2 cases of needle tract infection. Conclusion the treatment of AO/ASIF C type distal radius fractures can reach satisfactory clinical efficacy by two kinds of treatment methods. The overall effect of universal palmar double column LCP combined with Kirschner needle is a little better than external fixation. The fixation combined with Kirschner's acupuncture treatment group was superior to the latter in recovery of palmar angle, joint surface evenness, wrist flexion and dorsal extension activity, and there was no significant difference between the other imaging indexes and wrist activity degree of two. The universal palmar double column LCP combined with Kirschner needle could achieve satisfactory reduction and maintain reduction, early functional exercise after operation, and complications after operation. The results of the wrist joint function are less satisfactory. It is an alternative method for the treatment of AO/ASIF C distal radius fractures. The clinical choice of the treatment can be based on the patient's condition. The bone graft in the orthopedics can support the effective support of the internal plant and promote the healing of the fracture.

【学位授予单位】：山东大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R687.3

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