蓝芳令

[摘要]目的 探討切开复位钢板内固定在桡骨远端不稳定骨折患者中的应用效果。方法 选取2014年6月～2018年6月我院收治的45例桡骨远端不稳定骨折患者作为研究对象，根据随机数字表法分为内固定组（n=25）和外固定组（n=20）。内固定组患者采用切开复位钢板内固定治疗，外固定组患者采用外固定器治疗。比较两组患者的掌倾角、尺偏角、骨性愈合时间、腕关节活动度、腕关节功能Robbins评分及临床疗效。结果 内固定组患者的掌倾角、尺偏角均大于外固定组，差异有统计学意义（P<0.05）;内固定组患者的骨性愈合时间短于外固定组，差异有统计学意义（P<0.05）;内固定组患者的腕关节掌屈度、背伸度、旋前度、旋后度均大于外固定组，差异有统计学意义（P<0.05）;两组患者的腕关节桡偏度、尺偏度比较，差异均无统计学意义（P>0.05）;两组患者治疗后的腕关节功能Robbins评分均高于治疗前，差异有统计学意义（P<0.05）;内固定组患者治疗后的腕关节功能Robbins评分高于外固定组，差异有统计学意义（P<0.05）;内固定组患者的治疗总有效率为96.0%，高于外固定组的70.0%，差异有统计学意义（P<0.05）。结论 切开复位钢板内固定在桡骨远端不稳定骨折患者中的应用效果较外固定器治疗好，更能有效扩大患者的掌倾角、尺偏角、腕关节掌屈度、背伸度、旋前度、旋后度，缩短患者的骨性愈合时间，改善患者的腕关节功能，值得推广。

[关键词]桡骨远端不稳定骨折;切开复位钢板内固定;外固定器治疗;髋关节功能

[中图分类号] R683.4          [文献标识码] A          [文章编号] 1674-4721（2020）3（c）-0071-04

Application of open reduction and plate internal fixation in patients with unstable fracture of distal radius

LAN Fang-ling

Department of Orthopaedics， Yangchun People′s Hospital in Guangdong Province， Yangchun   529600， China

[Abstract] Objective To explore the application effect of open reduction and plate internal fixation in patients with unstable fractures of the distal radius. Methods Forty-five patients with unstable distal radius fractures treated in our hospital from June 2014 to June 2018 were selected as the subjects. They were divided into internal fixation group （n=25） and external fixation group （n=20） by random number table method. The internal fixation group was treated with open reduction and plate internal fixation， and the external fixation group was treated with external fixator treatment. The palm tilt， ulnar deflection angle， osseous healing time， wrist mobility， Robbins score of wrist function， clinical efficacy between the two groups were compared. Results The palm tilt and ulnar deflection angle of the patients in the internal fixation group were greater than those in the external fixation group， and the differences were statistically significant （P<0.05）. The osseous healing time in the internal fixation group was shorter than that in the external fixation group， and the difference was statistically significant （P<0.05）. The palmar flexion， dorsiflexion， pronation， supination of the patients in the internal fixation group were greater than those in the external fixation group， and the differences were statistically significant （P<0.05）. There was no significant difference between the two groups in radial and ulnar deflection angle （P>0.05）. The Robbins scores of wrist function in the two groups after treatment were higher than those before treatment （P<0.05）. The Robbins score of wrist function in the internal fixation group was higher than that in the external fixation group， the difference was statistically significant （P<0.05）. The total effective rate of treatment in the internal fixation group was 96.0%， which was higher than that in the external fixation group （70.0%）， the difference was statistically significant （P<0.05）. Conclusion The application effect of open reduction and plate internal fixation in patients with unstable fractures of the distal radius is better than external fixation， and it can effectively expand the patients′ palm tilt， ulnar deflection angle， palmar flexion， dorsiflexion， pronation and supination， shorten the osseous healing time， and improve the wrist function of patients， which is worth promoting.

[Key words] Unstable distal radius fracture; Open reduction and plate internal fixation; External fixator treatment; Hip joint function

桡骨远端不稳定骨折在骨科临床较为常见，传统手法整复小夹板外固定或石膏外固定等保守治疗具有较差的关节面、固定复位稳定性，极易引发创伤性关节炎并发症，对关节功能的有效恢复造成不良影响[1]。外固定器结合手法复位桡骨远端稳定骨折能够获得良好的临床效果，但是在不稳定骨折的治疗中缺乏理想的效果，目前临床还没有统一桡骨远端不稳定骨折的治疗标准及具体治疗方式。在桡骨远端不稳定骨折的治疗中，切开复位钢板内固定治疗较外固定器治疗更能促进患者骨性愈合，从而缩短愈合时间，将患者的腕关节活动能力早期恢复过来，具有较高的安全性与较为理想的治疗效果。……