| CO接骨架与钢板内固定术治疗不稳定型桡骨远端骨折近期临床疗效比较 |
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Received:September 10, 2024
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| 作者 | Author | 单位 | Unit | E-Mail |
| 伏敏睿 |
FU Min-rui |
中国中医科学院望京医院, 北京 100102 |
Wangjing Hospital of China Academy of Chinese Medical Sciences, Beijing 100102, China |
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| 史长龙 |
SHI Chang-long |
中国中医科学院望京医院, 北京 100102 |
Wangjing Hospital of China Academy of Chinese Medical Sciences, Beijing 100102, China |
shichanglong126@126.com |
| 成永忠 |
CHENG Yong-zhong |
中国中医科学院望京医院, 北京 100102 |
Wangjing Hospital of China Academy of Chinese Medical Sciences, Beijing 100102, China |
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| 马明明 |
MA Ming-ming |
北京中医药大学, 北京 100029 |
Beijing University of Traditional Chinese Medicine, Beijing 100029, China |
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| 牛正麟 |
NIU Zheng-lin |
中国中医科学院望京医院, 北京 100102 |
Wangjing Hospital of China Academy of Chinese Medical Sciences, Beijing 100102, China |
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| 孙海翔 |
SUN Hai-xiang |
北京中医药大学, 北京 100029 |
Beijing University of Traditional Chinese Medicine, Beijing 100029, China |
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| 高景华 |
GAO Jing-hua |
中国中医科学院望京医院, 北京 100102 |
Wangjing Hospital of China Academy of Chinese Medical Sciences, Beijing 100102, China |
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| 吴钟凯 |
WU Zhong-kai |
中国中医科学院望京医院, 北京 100102 |
Wangjing Hospital of China Academy of Chinese Medical Sciences, Beijing 100102, China |
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| 徐一鸣 |
XU Yi-ming |
中国中医科学院望京医院, 北京 100102 |
Wangjing Hospital of China Academy of Chinese Medical Sciences, Beijing 100102, China |
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| 期刊信息：《中国骨伤》2025年38卷，第1期，第10-17页 |
| DOI：10.12200/j.issn.1003-0034.20240447 |
| 基金项目:北京市科技计划课题(编号:Z211100002921021) |
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目的: 探讨中医接骨学(Chinese osteosynthesis，CO)理论指导下接骨支架与切开复位钢板内固定在治疗不稳定型(AO-23C型)桡骨远端骨折的近期临床疗效。
方法: 回顾性分析2022年1月至2023年2月48例不稳定型桡骨远端骨折患者，分为CO接骨架组和内固定组。CO接骨架组25例，男 7 例，女 18 例;年龄 37~56(52.6±11.3)岁;车祸伤7例，跌伤18例;闭合性骨折 25 例，开放性骨折 0 例;采用闭合复位CO接骨支架治疗。内固定组23例，男 8 例，女 15 例;年龄 41~59(53.3±13.7)岁;车祸伤 8 例，摔伤 15 例;闭合性骨折 23 例;采用切开复位钢板内固定方法。评价两组的围手术期资料(受伤至手术时间、手术时长、失血量、住院时间)、术后1年上肢功能障碍评分量表(disabilities of the arm，shoulder and hand，DASH)缩略版(QuickDASH)评分、疼痛视觉模拟评分(visual analogue scale，VAS)、活动范围及握力评估、影像学表现(掌倾角、尺偏角、桡骨长度、关节面台阶、关节内间隙)和并发症等情况。
结果: 两组术后均获随访，时间 0~24(16.0±3.8)个月。CO接骨架组和内固定组比较，CO接骨架组受伤至手术时间[(2.4±3.3) d vs (7.4±3.7) d]短，手术时间[(56.27±15.23) min vs (74.10±5.26) min]短、失血量[(14.52±6.54) ml vs (32.32±10.03) ml]少、住院时间[(14.04±3.24) d vs (16.45±3.05) d]少(P<0.05)。术后12个月两组QuickDASH评分比较[(9.21±1.64) 分 vs (7.04±3.64)分]，差异无统计学意义(P>0.05)。术后6周及1、3个月两组VAS 比较，差异均无统计学意义(P>0.05)。末次随访两组活动范围及握力比较，差异均无统计学意义(P>0.05)。术后12个月与内固定组影像学比较，CO接骨架组掌倾角[(17.90±2.18)° vs (19.87±3.21)°]更小、关节面台阶[(0.11±0.03) mm vs (0.17±0.02) mm]更少、桡骨长度[(8.16±1.11) mm vs (9.59±1.02) mm]更短(P<0.05);两组尺偏角度数、关节内间隙比较，差异均无统计学意义(P>0.05)。其中CO接骨架组(25例中的23例)和内固定组(23例中的21例)存在允许范围内的缩小，差异无统计学意义(P=0.29);两组并发症比较，差异无统计学意义(P>0.05)。
结论: CO接骨架和切开复位钢板内固定均是治疗不稳定型桡骨远端骨折的有效疗法，且接骨支架术从受伤至手术的等待时间更短、术中出血更少、耗时更短;钢板内固定术控制桡骨短缩更优。 |
| [关键词]:桡骨远端骨折 不稳定型 CO接骨架 钢板内固定 |
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| Comparison of short-term clinical efficacy between CO external fixation and internal fixation with steel plate in the treatment of unstable distal radius fractures |
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Abstract:
Objective To evaluate the short-term clinical efficacy of external fixation and internal fixation with steel plate in the treatment of unstable distal radius fractures (AO-23C type),based on the principles of Chinese osteosynthesis (CO).
Methods Forty-eight patients with unstable distal radius fractures between January 2022 and February 2023 were retrospectively analyzed and divided into the CO external fixation group and internal fixation group. CO external fixation group consisted of 25 patients,including 7 males and 18 females,aged from 37 to 56 years old with an average of (52.6±11.3) years old. Among them,there were 7 patients of traffic accidents and 18 patients of falls,resulting in a total of 25 patients of closed fractures and no open fractures,the treatment was conducted using closed reduction and CO external fixation. The internal fixation group consisted of 23 patients,comprising 8 males and 15 females,age ranged from 41 to 59 years old,with an average age of(53.3±13.7) years old. Among them,8 patients resulted from car accidents while the remaining 15 patients were caused by falls. All 23 patients were closed fractures without any open fractures observed. The technique of open reduction and internal fixation with steel plate was employed. The perioperative data,including injury-operation time,operation duration,blood loss,and length of hospital stay,were assessed in both groups. Additionally,the QuickDASH score and visual analogue scale (VAS) were evaluated. Range of motion and grip strength assessment,imaging findings such as palmar inclination angle,ulnar declination angle,radius length,articular surface step,intra-articular space measurements were also examined along with any complications.
Results The follow-up duration ranged from 0 to 24 months,with an average duration of (16.0±3.8) months. The CO external fixation exhibited significantly shorter time from injury to operation (2.4±3.3) d vs (7.4±3.7) d,shorter operation duration (56.27±15.23) min vs (74.10±5.26) min,lower blood loss (14.52±6.54) ml vs (32.32±10.03) ml,and reduced hospitalization days (14.04±3.24)d vs (16.45±3.05) d compared to the internal fixation group (P<0.05). The QuickDASH score at 12 months post-operation was (8.21±1.64) in the CO external fixation group,while no significant difference was observed in the internal fixation group (7.04±3.64),P>0.05. There were no statistically significant differences in VAS between two groups at 6 weeks,as well as 1 and 3 months post-surgery (P>0.05). Additionally,there were no significant disparities observed in terms of range of motion and grip strength between two groups at the 2-year follow-up after the operation (P>0.05). After 12 months of surgery,the CO external fixation group exhibited a significantly smaller palmar inclination angle (17.90±2.18) ° vs (19.87±3.21)°,reduced articular surface step (0.11±0.03) mm vs (0.17±0.02) mm,and shorter radius length (8.16±1.11) mm compared to the internal fixation group (9.59±1.02) mm,P<0.05. The ulnar deviation angle and intra-articular space did not show any significant difference between two groups (P>0.05). The reduced fell within the allowable range between the CO external fixation group (23 out of 25 cases) and the internal fixation group (21 out of 23 cases) was not statistically significant (P=0.29). There was no significant difference in complications between the two groups(P>0.05).
Conclusion Both the CO external fixation and open reduction with plate internal fixation demonstrate clinical efficacy in managing unstable distal radius fractures. The CO external fixation offers advantages in shorter injury-to-operation times,reduced intraoperative blood loss,and decreased surgical durations,while radial shortening is more effectively controlled by internal fixation. |
| KEYWORDS:Distal radius fractures Unstable type CO external fixation Internal plate fixation |
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| 引用本文，请按以下格式著录参考文献： |
| 中文格式: | 伏敏睿,史长龙,成永忠,马明明,牛正麟,孙海翔,高景华,吴钟凯,徐一鸣.CO接骨架与钢板内固定术治疗不稳定型桡骨远端骨折近期临床疗效比较[J].中国骨伤,2025,38(1):10~17 |
| 英文格式: | FU Min-rui,SHI Chang-long,CHENG Yong-zhong,MA Ming-ming,NIU Zheng-lin,SUN Hai-xiang,GAO Jing-hua,WU Zhong-kai,XU Yi-ming.Comparison of short-term clinical efficacy between CO external fixation and internal fixation with steel plate in the treatment of unstable distal radius fractures[J].zhongguo gu shang / China J Orthop Trauma ,2025,38(1):10~17 |
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