刘海恩+郭怀虎

[摘 要] 目的：比较双钢板、双髓内钉、髓内钉加桡骨动力加压钢板3种固定方式治疗尺桡骨双骨折的临床疗效与安全性。方法：将2012年7月至2014年7月126例尺桡骨双骨折患者，按照随机数字表法分为A组双钢板、B组双髓内钉、C组髓内钉加桡骨动力加压钢板各42例，随访比较3组患者治疗情况、骨愈合时间、前臂功能恢复情况及术后并发症发生情况，探讨最佳固定方式。结果：C组手术时间、切口长度、术中出血量、住院时间、术后1～3 d VAS评分、愈合时间均低于A组，B组上述指标均低于C组；B组、C组末次随访时前臂旋前、旋后角度均高于A组，差异有统计学意义（P<0.05）。C组并发症发生率低于A组、B组，B组、C组临床优良率高于A组，差异有统计学意义（P<0.05）。结论：较双钢板固定而言，双髓内钉固定、尺桡骨髓内钉加桡骨动力加压钢板固定具有更好的临床疗效，而尺桡骨双髓内钉固定具有更佳的安全性，能够保证患者早期恢复效果。

[关键词] 尺桡骨双骨折；钢板；髓内钉；动力加压钢板

中图分类号：R683.42 文献标识码：A 文章编号：2095-5200（2017）03-099-03

DOI：10.11876/mimt201703041

[Abstract] Objective： This study aimed to compare the clinical efficacy and safety of the three kinds of fixation methods of double plate， double intramedullary nail and intramedullary nail plus radial dynamic compression plate for the treatment of double fracture of ulnar and radius. Methods： A total sample of 126 patients with double fracture of ulnar and radius treated from July 2012 to July 2014， were selected and divided into group A （double plate）， group B （double intramedullary nail） and group C（ intramedullary nail plus radial dynamic compression plate） according to random number table method， with each 42 cases. The patients of three groups were followed up to compare the treatment efficacy， bone healing time， forearm function recovery and postoperative complications， and thus to analyse the best fixation method. Results： The operative time， incision length， intraoperative blood loss， hospitalization time， VAS score and healing time were lower in group C than those in group A， and the same six parameters in group B was lower than those in group C； the angles of forearm pronation and supination in group B and group C at the time of the last follow-up were higher than those in group A （P<0.05）， and the difference was statistically significant （P<0.05）. The incidence of complication in group C was lower than those in groups A and B， the rates of good clinical result in group B and group C were better than that in group A， and the difference was statistically significant （P<0.05）. Conclusions： Compared with double plate fixation， the fixations of intramedullary nail and intramedullary nail plus radial compression plate have better clinical curative effect， and the double intramedullary nail fixation for double fracture of ulnar and radius has better safety and ensure early recovery effect.

[Key words] ulnar radius double fracture； plate； intramedullary nail； radial dynamic compression plate

尺橈骨双骨折好发于少年儿童，由于学龄前儿童具有骨骼塑形能力强、愈合速度快的特点，保守治疗可取得一定效果 [1]。但对年龄偏大及骨折断端解剖对位对线要求较高患儿行手法复位往往难以保证满意位置，甚至造成畸形愈合等后果，影响前臂功能[2]。对于该类患者，常用的尺桡骨双骨折固定方式包括尺桡骨双钢板固定、尺桡骨双髓内钉固定、尺桡骨髓内钉加桡骨动力加压钢板固定等 [3]。本研究就上述3种固定方式的疗效与安全性进行了比较。

1 资料与方法

1.1 一般资料

2012年7月—2014年7月收治的126例尺桡骨双骨折患者，均有明确的外伤史，骨折至手术时间<7 d且未合并其他血管神经严重损害，排除合并病理性骨折、其他部位骨折及畸形者[4]，按照随机数字表法分为A组、B组、C组，各42例。……