马成才,张琪琪,丁超,张伟

• 1:亳州市人民医院关节外科

摘要(Abstract)：

[目的]比较掌侧锁定钢板（volar locking plate, VLP）与外固定架联合经皮克氏针固定不稳定性桡骨远端骨折（unstable distal radius fractures, UDRF）的临床疗效。[方法]回顾性分析2018年1月—2020年1月本院手术收治的73例UDRF患者的临床资料。依据术前医患沟通结果，41例采用VLP内固定（内固定组），32例采用外固定架联合经皮克氏针固定（外固定组）。比较两组围手术期、随访期及影像学资料。[结果]两组均顺利完成手术，虽然内固定组手术时间显著长于外固定组，但术中透视次数、早期VAS评分均显著优于外固定组（P<0.05）。术后并发症总发生率内固定组为7.3%，外固定组为25.0%，差异有统计学意义（P<0.05）。平均随访（15.3±2.1）个月，内固定组恢复完全负重活动时间显著早于外固定组（P<0.05）。术后内固定组Cooney评分、腕掌屈-背伸ROM、腕尺偏-桡偏ROM、前臂旋前-旋后ROM均优于外固定组（P<0.05）。影像方面，术后即刻和末次随访时，内固定组的PT、RI、RL和关节面对合分级均显著优于外固定组（P<0.05）。影像显示内固定组骨折愈合时间显著早于外固定组（P<0.05）。[结论]与外固定架联合克氏针外固定相比，VLP内固定早期不良反应轻，功能恢复好，更有利于骨折愈合。

关键词(KeyWords)： 不稳定性桡骨远端骨折;内固定;掌侧锁定钢板;外固定架;经皮克氏针

Abstract:

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基金项目(Foundation):

作者(Author): 马成才,张琪琪,丁超,张伟

参考文献(References)：

• [1] Zemirline A, Taleb C, Naito K, et al. Distal radius fracture fixation with a volar locking plate and endoscopic carpal tunnel release using a single 15mm approach:feasibility study[J]. Hand Surg Rehabil, 2018, 37(4):231-237.
• [2]蒋仕林,刘大林,占先方,等.背侧入路在涉及背侧不稳定桡骨远端骨折治疗中运用[J].中国矫形外科杂志, 2020, 28(4):375-377.
• [3]王海羽,汤立新,郭雄飞,等.内固定与外固定桡骨远端C2和C3型骨折的比较[J].中国矫形外科杂志, 2021, 29(8):684-688.
• [4] Krustins U, Krustins J, Bringina D, et al. Comparison of volar locking plates with external fixation and K-wires in arthroscopically assisted intra-articular distal radial fracture fixation[J]. J Hand Surg Eur, 2020, 45(4):333-338.
• [5] Ludvigsen T, Matre K, Gudmundsdottir RS, et al Surgical treatment of distal radial fractures with external fixation versus volar locking plate:a multicenter randomized controlled trial[J]. J Bone Joint Surg Am, 2021, 103(5):405-414.
• [6]陈君生,梁晓松,李昊,等.掌侧锁定钢板治疗老年骨质疏松性桡骨远端骨折[J].中国矫形外科杂志, 2019, 27(21):2010-2011.
• [7] Lawson A, Na M, Naylor JM, et al. Volar locking plate fixation versus closed reduction for distal radial fractures in adults:a systematic review and meta-analysis[J]. JBJS Rev, 2021, 9(1):e20.00022.
• [8] Ermutlu C, Mert M, Kovalak E, et al. Management of distal radius fractures:comparison of three methods[J]. Cureus, 2020, 12(8):e9875.
• [9]姚晓克,伍玲娜,李建华,等.掌侧斜T型锁定钢板排钉杠杆复位内固定治疗桡骨极远端骨折[J].中国修复重建外科杂志,2020, 34(7):809-813.
• [10] Hammer OL, Jakobsen RB, Benth J?, et al. Can generic outcome questionnaires replace quickDASH in monitoring clinical outcome following surgical treatment of distal radius fractures[J]. J Hand Surg Am, 2022, 47(1):92e1-92e9.
• [11] Woolnough T, Axelrod D, Bozzo A, et al. What is the relative effectiveness of the various surgical treatment options for distal radius fractures? A systematic review and network meta-analysis of randomized controlled trials[J]. Clin Orthop, 2021, 479(2):348-362.
• [12]常西海,王宝鹏,魏勇,等.两种复位固定方式治疗不稳定型桡骨远端骨折[J].中国矫形外科杂志, 2020, 28(8):712-716.
• [13] Ochen Y, Peek J, Van der velde D, et al. Operative vs nonoperative treatment of distal radius fractures in adults:a systematic review and meta-analysis[J]. JAMA Open, 2020, 3(4):e203497.
• [14]卓金,王莎莎,陈其强,等. C型桡骨远端骨折患者腕关节功能及骨折复位质量:克氏针辅助外固定架、外固定架及掌侧入路钢板内固定的比较[J].中国组织工程研究, 2019, 23(32):5126-5132.
• [15]王星亮,华国军,杨家骥,等.锁定钢板内固定与外固定支架治疗C型桡骨远端骨折的比较[J].中国矫形外科杂志, 2018, 26(12):1074-1079.
• [16] Di Giacinto S, Pica G, Stasi A, et al. The challenge of the surgical treatment of paediatric distal radius/forearm fracture:K wire vs plate fixation-outcomes assessment[J]. Med Glas(Zenica),2021, 18(1):208-215.
• [17]常西海,王宝鹏,魏勇,等.两种复位固定方式治疗不稳定型桡骨远端骨折[J].中国矫形外科杂志, 2020, 28(8):712-716.
• [18] Van Egmond JC, Selles CA, Cleffken BI, et al. Plate fixation for unstable displaced distal radius fractures in children[J]. J Wrist Surg, 2019, 8(5):384-387.
• [19] Quadlbauer S, Pezzei C, Jurkowitsch J, et al. Functional and radiological outcome of distal radius fractures stabilized by volar-locking plate with a minimum follow-up of 1 year[J]. Arch Orthop Trauma Surg, 2020, 140(6):843-852.
• [20]吴晓林,钟伟,梁答,等.两种固定方式治疗老年骨质疏松性桡骨远端骨折的比较[J].中国矫形外科杂志, 2020, 28(6):512-516.
• [21] Lizaur-Utrilla A, Martinez-Mendez D, Vizcaya-Moreno MF, et al.Volar plate for intra-articular distal radius fracture. a prospective comparative study between elderly and young patients[J]. Orthop Traumatol Surg Res, 2020, 106(2):319-323.
• [22] Ahmed M, Ahmed N, Kumar S, et al. Functional outcome of intraarticular fracture of distal radius managed by volar locking plate[J].Cureus, 2020, 12(10):e11271.