| 郑永嘉,梅伟.外固定支架联合克氏针与掌侧锁定钢板内固定治疗AO-C型桡骨远端骨折的疗效比较.骨科,2025,16(5): 399-405. |
| 外固定支架联合克氏针与掌侧锁定钢板内固定治疗AO-C型桡骨远端骨折的疗效比较 |
| Comparison of efficacy between external fixator combined with Kirschner wires and volar locking plate internal fixation for AO type C distal radius fractures |
| 投稿时间：2025-02-25 |
| DOI：10.3969/j.issn.1674-8573.2025.05.003 |
| 中文关键词: 掌侧锁定钢板 外固定支架 桡骨远端骨折 克氏针 AO-C型骨折 |
| 英文关键词: Volar locking Plate External fixator Distal radius fracture Kirschner wire AO type C fractures |
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| 中文摘要: |
| 目的 探讨外固定支架联合克氏针与掌侧锁定钢板内固定在AO-C型桡骨远端骨折治疗中的疗效差异。方法 回顾性分析我院收治的60例AO-C型桡骨远端骨折病人的临床资料，根据内固定方式不同，将病人分为钢板组（30例，行掌侧锁定钢板内固定）和外固定组（30例，行外固定支架联合克氏针固定）。对比两组术中出血量、手术时长、切口总长度、住院时间等，以及术后即刻、6个月、12个月掌倾角与尺偏角度数。分别于术后6个月、12个月，评估病人腕关节活动度以及Cooney腕关节功能评分。比较不同AO分型（C1/C2/C3）下，两组病人术后12个月Cooney评分、掌屈活动度的差异。结果 所有病人手术均顺利完成，随访时间为12~15个月，钢板组内固定物在研究期内未取出，外固定组外固定支架联合克氏针在术后8~12周于门诊拆除。外固定组在术中出血量、手术时长和切口总长度方面较钢板组优势显著（P＜0.05），两组住院时间的差异无统计学意义（P＞0.05）。术后即刻、6个月以及12个月，与外固定组相比，钢板组掌倾角与尺偏角的恢复呈现出显著优势（P＜0.05）。术后6个月，钢板组腕关节活动度和Cooney腕关节功能评分优于外固定组（P＜0.05），术后12个月，两组数据较前均有明显改善，但两组间差异无统计学意义（P＞0.05）。不同AO分型亚组分析显示，C3型骨折病人术后12个月，钢板组Cooney评分及掌屈活动度显著优于外固定组（P＜0.05），而C1和C2型骨折病人组间差异无统计学意义（P＞0.05）。随访期间，钢板组出现1例肌腱粘连，外固定组出现1例固定物松动，3例关节僵硬，经及时处理，均未产生严重不良影响，且两组均未发生切口感染、骨折不愈合及血管神经损伤等严重并发症。结论 掌侧锁定钢板内固定与外固定支架联合克氏针均是治疗AO-C型桡骨远端骨折的有效手段。外固定支架联合克氏针在术中出血量、手术时长和切口长度上优势明显，能有效降低手术感染风险，利于病人早期康复，且不需要进行二次手术，病人接受度高。掌侧锁定钢板内固定术后骨折复位质量高，尤其适用于C3型复杂关节内骨折的功能恢复。 |
| 英文摘要: |
| Objective To compare the therapeutic efficacy of external fixation combined with Kirschner wires versus volar locking plate internal fixation in the treatment of AO type C distal radius fractures. Methods A retrospective analysis was conducted on the clinical data of 60 patients with AO type C distal radius fractures admitted to our hospital. Based on the fixation method, patients were divided into two groups: the plate group (30 cases, treated with volar locking plate internal fixation) and the external fixator group (30 cases, treated with external fixation combined with Kirschner wires). Intraoperative blood loss, operation time, total incision length, and hospital stay were compared between the two groups. Radiographic parameters, including palmar tilt angle and ulnar deviation angle, were assessed immediately postoperatively, at 6th month, and at 12th month. Wrist range of motion (ROM) and Cooney wrist functional scores were evaluated at 6th and 12th month postoperatively. Differences in the 12-month Cooney score and palmar flexion ROM between the two groups were also compared across different AO subtypes (C1, C2, C3). Results All surgeries were successfully completed, with a follow-up period of 12-15 months. Implants in the plate group were not removed during the study period, while the external fixator and Kirschner wires in the external fixator group were removed in the outpatient clinic 8-12 weeks postoperatively. The external fixator group demonstrated significant advantages in intraoperative blood loss, operation time, and total incision length compared to the plate group (P＜0.05). There was no significant difference in hospital stay between the two groups (P＞0.05). At all postoperative time points (immediately, 6 months, and 12 months), the plate group showed significantly better restoration of both palmar tilt angle and ulnar deviation angle than the external fixator group (P＜0.05). At 6th month postoperatively, wrist ROM and Cooney scores were superior in the plate group to the external fixator group (P＜0.05). By 12 months postoperatively, both groups showed significant improvement in these parameters compared to earlier assessments, and the differences between the groups were no longer statistically significant (P＞0.05). Subgroup analysis based on AO classification revealed that for C3 type fractures at 12 months, the plate group had significantly better Cooney scores and palmar flexion ROM than the external fixator group (P＜0.05). No statistically significant differences were observed between the groups for C1 and C2 type fractures (P＞0.05). During follow-up, complications included 1 case of tendon adhesion in the plate group and 1 case of fixator loosening plus 3 cases of joint stiffness in the external fixator group. These were managed promptly without serious adverse effects. No severe complications such as wound infection, nonunion, or neurovascular injury occurred in either group. Conclusion Both volar locking plate internal fixation and external fixation combined with Kirschner wires are effective methods for treating AO type C distal radius fractures. External fixation combined with Kirschner wires offers significant advantages in terms of less intraoperative blood loss, shorter operation time, and smaller incision length, effectively lowering the risk of surgical infection, facilitating early rehabilitation, and eliminating the need for secondary surgery, resulting in higher patient acceptance. Volar locking plate internal fixation provides superior postoperative fracture reduction quality and is particularly advantageous for functional recovery in complex intra-articular C3 type fractures. |
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