本文選題：橈骨骨折 + 鎖定加壓鋼板�。� 參考：《山東大學(xué)》2016年碩士論文

【摘要】：目的通過對萬向掌側(cè)雙柱LCP聯(lián)合克氏針與外固定架結(jié)合克氏針治療AO/ASIFC型橈骨遠(yuǎn)端骨折的臨床效果對比分析,比較兩種方式優(yōu)缺點,探討AO/ASIF C型橈骨遠(yuǎn)端骨折的治療策略并為臨床治療提供指導(dǎo)。方法收集2012年1月至2015年1月期間在我院創(chuàng)傷骨科進(jìn)行治療的51例AO/ASIF C型橈骨遠(yuǎn)端骨折患者臨床資料,納入本研究并獲得長期隨訪滿意者34例,其中經(jīng)萬向掌側(cè)雙柱LCP聯(lián)合克氏針治療組20例,年齡31～68歲,平均(53.06±8.70)歲,按照AO/ASIF分型,其中C1型6例、C2型11例、C3型3例；超腕外固定架有限切口克氏針固定治療組14例,年齡28～70歲,平均(52.20±10.89)歲,按照AO/ASIF分型,其中C1型4例、C2型4例、C3型6例。兩組均為新鮮閉合性骨折。兩組骨缺損嚴(yán)重的病例均行植骨治療,術(shù)后常規(guī)康復(fù)治療。術(shù)后隨訪,比較兩組患者腕關(guān)節(jié)掌屈、背伸、橈偏、尺偏、旋前、旋后等各向活動度及掌傾角、尺偏角、橈骨莖突高度、關(guān)節(jié)面平整度等相關(guān)影像學(xué)資料,根據(jù)腕關(guān)節(jié)Gartland-Werley評分評估術(shù)后腕關(guān)節(jié)功能情況,改良Sarmiento評估影像學(xué)情況。結(jié)果所有患者均獲得隨訪,隨訪時間萬向掌側(cè)雙柱LCP聯(lián)合克氏針組12～36個月,平均(23.01±7.24)個月,超腕外固定架結(jié)合克氏針組12～40個月,平均(22.28±6.62)個月。愈合時間萬向掌側(cè)雙柱LCP聯(lián)合克氏針組平均(10.97±1.37)周,超腕外固定架結(jié)合克氏針組平均(11.48±1.64)周,無明顯統(tǒng)計學(xué)差異(P0.05)；兩組去除克氏針平均時間6周。7例植骨患者愈合良好。兩組患者尺偏角、橈骨莖突高度、腕關(guān)節(jié)Gartland-Werley評分、腕關(guān)節(jié)橈偏、尺偏、旋前、旋后活動均無顯著性差異。萬向掌側(cè)雙柱LCP聯(lián)合克氏針組掌傾角10.48°±1.48°,超腕外固定架結(jié)合克氏針組掌傾角4.94°±2.30°,萬向掌側(cè)雙柱LCP聯(lián)合克氏針組優(yōu)于外固定組,兩者差異具統(tǒng)計學(xué)意義(P0.05)；萬向掌側(cè)雙柱LCP聯(lián)合克氏針組關(guān)節(jié)面臺階(0.60±0.29)mm,外固定架組關(guān)節(jié)面臺階(1.50±0.24)mm,萬向掌側(cè)雙柱LCP聯(lián)合克氏針組優(yōu)于外固定架組,兩者差異具統(tǒng)計學(xué)意義(P0.05)；萬向掌側(cè)雙柱LCP聯(lián)合克氏針組改良Sarmiento評分(2.14±1.07)分,外固定架組改良Sarmiento評分(4.28±2.65)分,萬向掌側(cè)雙柱LCP聯(lián)合克氏針組優(yōu)于外固定組,兩者差異具統(tǒng)計學(xué)意義(P0.05);萬向掌側(cè)雙柱LCP聯(lián)合克氏針組掌屈64.88°-8.54°,外固定架組掌屈58.41°±5.52°,萬向掌側(cè)雙柱LCP聯(lián)合克氏針組優(yōu)于外固定組,兩者差異具統(tǒng)計學(xué)意義(P0.05)；萬向掌側(cè)雙柱LCP聯(lián)合克氏針組背伸66.22°±7.02°,外固定架組背伸60.88°±8.54°,萬向掌側(cè)雙柱LCP聯(lián)合克氏針組優(yōu)于外固定組,兩者差異具統(tǒng)計學(xué)意義(P0.05)。末次隨訪根據(jù)腕關(guān)節(jié)Gartland-Werley評分：萬向掌側(cè)雙柱LCP聯(lián)合克氏針組優(yōu)11例,良6例,可3例,優(yōu)良率85.0%,超腕外固定架結(jié)合克氏針組優(yōu)6例,良5例,可2例,差1例,優(yōu)良率78.6%；依照改良Sarmiento評分標(biāo)準(zhǔn)：萬向掌側(cè)雙柱LCP聯(lián)合克氏針組優(yōu)6例,良10例,可4例,優(yōu)良率80.0%,超腕外固定架結(jié)合克氏針組優(yōu)2例,良8例,可2例,差2例,優(yōu)良率71.4%。并發(fā)癥情況：萬向掌側(cè)雙柱LCP聯(lián)合克氏針組拇長伸肌腱斷裂1例,復(fù)雜區(qū)域疼痛綜合征1例,固定松動1例；外固定架組肌腱激惹1例,創(chuàng)傷性關(guān)節(jié)炎1例,固定松動1例,針道感染2例。結(jié)論兩種治療方式治療AO/ASIF C型橈骨遠(yuǎn)端骨折均可達(dá)較滿意臨床療效。萬向掌側(cè)雙柱LCP聯(lián)合克氏針治療組整體療效稍優(yōu)于外固定架結(jié)合克氏針治療組,在恢復(fù)掌傾角、關(guān)節(jié)面平整度,腕關(guān)節(jié)掌屈、背伸活動方面優(yōu)于后者；其余影像學(xué)指標(biāo)及腕關(guān)節(jié)活動度二者無顯著差異。萬向掌側(cè)雙柱LCP聯(lián)合克氏針可達(dá)較滿意復(fù)位并有效維持復(fù)位,術(shù)后早期功能鍛煉,并發(fā)癥較少,腕關(guān)節(jié)功能結(jié)果較滿意,是治療AO/ASIF C型橈骨遠(yuǎn)端骨折可供選擇的方法。臨床可依據(jù)患者情況合理選擇治療方式。術(shù)中植骨糾正骨缺損可輔助維持內(nèi)植物的有效支撐及促進(jìn)骨折愈合。
[Abstract]:Objective to compare the clinical effects of the LCP combined Kirschner pin combined with Kirschner pin with the external fixator and Kirschner pin for the treatment of AO/ASIFC type distal radius fractures, and compare the advantages and disadvantages of the two methods, and discuss the treatment strategy of the AO/ASIF C type distal radius fracture and provide guidance for clinical treatment. Methods collect the period from January 2012 to January 2015. The clinical data of 51 cases of AO/ASIF C distal radius fracture treated in our hospital trauma department of orthopedics were included in this study and 34 cases were satisfied with long-term follow-up, of which 20 cases were treated by universal palmar double column LCP combined with Kirschner needle, age 31~68 years old, with an average of (53.06 + 8.70) years, in which 6 cases of C1, 11 cases of C2, 3 cases of C3 type. 14 cases of Kirschner needle fixation in the limited incision of the external fixator were 28~70 years old, with an average age of (52.20 + 10.89) years old, according to the AO/ASIF typing, among which 4 cases were C1, 4 C2, 6 of C3. All cases of severe bone defect were treated with bone graft and routine rehabilitation after operation. Two groups of patients were followed up after operation, two groups were compared. Wrist joint flexion, dorsal extension, radial deviation, ulnar deviation, pronation, rotation and other isotropic activity and palmar angle, ulnar angle, height of the styloid process of the radius, joint surface evenness and other related imaging data. The wrist joint function was evaluated according to Gartland-Werley score of wrist joint, and Sarmiento was improved to evaluate imaging. All patients were followed up. All patients were followed up, followed up, follow up, follow up, follow up, follow up, follow up with all patients, follow up, follow up LCP combined Kirschner's needle group for 12~36 months, the average (23.01 + 7.24) months, the extra wrist external fixator combined with Kirschner's needle group for 12~40 months, averaging (22.28 + 6.62) months. The average healing time was (10.97 + 1.37) weeks (10.97 + 1.37) weeks, and the extra wrist external fixator combined with Kirschner's needle group was (11.48 + 1.64) weeks). There was no significant difference in Statistics (P0.05); two groups of patients with Kirschner's average time of 6 weeks were healed well. The two groups had no significant difference between the ulnar angle, the height of the styloid process of the radius, the wrist joint Gartland-Werley score, the wrist joint radial deviation, the ulnar deviation, the pronation and the rotation, and the volar side double column LCP combined with the Kirschner group's palmar angle of 10.48? 1.48. In combination with Kirschner's acupuncture group and Kirschner's needle group, the palmar angle was 4.94 and 2.30 degrees, and the LCP combined Kirschner pin group was superior to the external fixation group. The difference was statistically significant (P0.05); the joint surface steps (0.60 + 0.29) mm of the universal palmar double column LCP combined with Kirschner needle, the joint surface steps (1.50 + 0.24) mm in the external fixator group and the universal palmar double column LCP The group of Kirschner's needle group was better than the external fixator (P0.05), and the modified Sarmiento score (2.14 + 1.07) of the LCP combined with Kirschner needle in the cardan side double column group and the improved Sarmiento score of the external fixator group (4.28 + 2.65), and the universal palmar double column LCP combined Kirschner group were superior to those in the external fixation group, and the difference was statistically significant (P0.05 The volar side double column LCP combined with Kirschner's hand flexion 64.88 degrees -8.54 degrees, the external fixator group palmar flexion 58.41 + 5.52 degrees, the universal palmar double column LCP Kirschner group is superior to the external fixation group, the difference has statistical significance (P0.05), the cardan side double column LCP combined Kirschner group's back extension 66.22? 7.02 degrees, the external fixator's back extension 60.88? 8.54 [8.54], 10000 The two column LCP combined with Kirschner needle group was superior to the external fixation group (P0.05). The last follow-up was based on the wrist joint Gartland-Werley score: 11 cases of universal palmar double column LCP combined with Kirschner needle, good in 3 cases, good rate 85%, superior wrist external fixator combined with Kirschner needle, good in 6 cases, good 5 cases, 2 cases, and poor 1 cases. Rate 78.6%, according to the improved Sarmiento score standard: 6 cases of universal palmar double column combined with Kirschner needle, good 10 cases, 4 cases, good rate 80%, excellent 2 cases of super wrist external fixator combined with Kirschner needle, 8 good cases, 2 cases, 2 poor cases, and good rate of 71.4%. complications: 1 cases, complex and complex fracture of hallux extensor tendon of universal palm side double column LCP combined Kirschner needle group, complex and complex 1 cases of regional pain syndrome, 1 cases of fixed loosening, 1 cases of tendon irritation in external fixator group, 1 cases of traumatic arthritis, 1 cases of fixed loosening, 2 cases of needle tract infection. Conclusion the treatment of AO/ASIF C type distal radius fractures can reach satisfactory clinical efficacy by two kinds of treatment methods. The overall effect of universal palmar double column LCP combined with Kirschner needle is a little better than external fixation. The fixation combined with Kirschner's acupuncture treatment group was superior to the latter in recovery of palmar angle, joint surface evenness, wrist flexion and dorsal extension activity, and there was no significant difference between the other imaging indexes and wrist activity degree of two. The universal palmar double column LCP combined with Kirschner needle could achieve satisfactory reduction and maintain reduction, early functional exercise after operation, and complications after operation. The results of the wrist joint function are less satisfactory. It is an alternative method for the treatment of AO/ASIF C distal radius fractures. The clinical choice of the treatment can be based on the patient's condition. The bone graft in the orthopedics can support the effective support of the internal plant and promote the healing of the fracture.

【學(xué)位授予單位】：山東大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2016
【分類號】：R687.3

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