| Objective: Distal radius fractures are common clinical fractures,which divide into three subtypes:A?B?C,Especially C type of AO type fractures,which involves the articular surface at the same time,including the complete separation of epiphysis and backbone of all the distal radius fractures.It divides into three subtypes,C1 subtype:Joint broken into 2 fragments,Metaphysis without crushing.C2 subtype:Joint broken into 2 fragments,Metaphysis crushing.C3 subtype:Joint and Metaphysis crushing.The purpose of this paper is to compare the clinical effects of two internal fixation methods of locking compression plate and external fixator in the treatment of C2 type fractures of the distal radius.Methods: Seventy nine cases of distal radius fracture were chosen from March 2014 to March 2017,of which 40 cases were male and 39 were female.The age ranged from 43 to 75 years old and the average age was 56.According to AO classification:They were all C2 type.Standards: 1.type C2 of AO type distal radius fractures by imaging check(Joint broken into 2 fragments,Metaphysis crushing.);2.There were unstable or potentially unstable fracture;and failed after manipulative reduction and fixation,radius shorter after reduction > 3 mm,dorsal tilt > 10 degrees,obvious displacement or step over of intra-articular fracture block >2 mm;3.Reliable and able to complete follow-up visit.Exclusion criteria: 1.AO type A/B/C1/C3 type fracture of the stable distal radius fracture 2.persons with important nerve,blood vessel,and tendon injury.3.Serious pollution of open fracture;4.persons with autoimmune diseases,coagulation disorders,hematological diseases,severe organic diseases,disturbance of consciousness,important organ dysfunction or malignant tumors.5.pathological fracture.6.Excessive age(>75 years old),mental disorder and poor compliance,affecting communication,evaluation and follow-up.Emergency surgery was performed in 22 cases,and the surgery of other cases was performed within 3-5 days after injury.It was randomly divided into 2 groups:Group A:3mm longitudinal Henry incision between the flexor carpi carpal muscle and the palmar muscle of the palmar,Dissect the skin with blunt separation,Pull the flexor pollicis long flexor tendons to the radial side,pull the median nerve and other tendons to the ulnar side,pay attention to the protection of the radial artery,take incision of the anterior muscle and part of joint capsule,Expose fracture and distal articular surface,assist reduction of Kirschner's needle by pry and pr,Restore the flatness,radial axial length,palmar angle and ulnar angle of the distal radius of the radius,fix Kirschner's needle temporarily,select T type locking compression plate with appropriate length(Slhui orthopedics equipment company),take equal length plate and make an 5mm small incision on the skin in the near end surface projection nail hole,Blunt dissect the subcutaneous tissue forceps,Do not damage the median nerve,radial artery,and flexor tendon.The Kirschner wire was fixed on the proximal and distal ends of the steel plate.The "C" arm showed that the fractures were good for alignment,and the proximal part of the steel plate was located at the backbone center.After entering the distal locking pin,the proximal locking screws were screwed into the proximal ends.Group B:Closed reduction of external fixator fixation group,operation in the operating room under brachial plexus block anesthesia,the patient takes supine position,in the 2nd metacarpal bone radial dorsal side do 2 longitudinal operation incision,each about 5mm,after incision skin,the blood vessel clamp blunt separation subcutaneous,until the metacarpal bone,the attention does not injure extensor tendon,the sleeve protects under the drill in 2nd The metacarpal shaft is drilled,screwed into 2 external fixation screws,and is approximately 35 mm at the proximal end of the radial fracture line,do 2 5mm longitudinal incision,pay attention to the operation of sleeve protection,blunt separation under the skin,do not damage radial nerve shallow branch,sleeve protection under the drilling,screw 2 external fixation screws,adjust the bracket,C arm x Under the wire machine perspective traction manipulation Reset,“C” arm perspective shows: radial length,palm inclination and ulnar deflection,etc.restored to normal or near normal,the external fixator fixed tightly(Jiangsu Hundred Yi Medical Technology Co.,Ltd.)After the steel plate is shaped,drill directly and screw into the far and near end screw.Compare the fracture healing time,imaging index(Palm inclination angle,ulnar deviation angle,radius shortening,articular surface collapse)and wrist joint functions between the two groups.Evaluate clinical efficacy according to Gartland-Werley(Gw)evaluation system.Results:1.General comparison between group A and group B:There was no significant difference in the general data of age,sex and type of fracture between the two groups(P>0.05).Comparability exists.2.These two groups were followed up with 2~16 months(average 7.1 months).By comparing the two kinds of treatment methods,the average fracture healing time was 10.1±0.3 weeks for group A and 9.9±0.5 weeks for group B.the difference of fracture healing time in group A and B was not significant,there was no significant difference between the two groups after operation P>0.05).According to the posto-perative and follow-up review X-ray measurement of volar tilt,radial inclination,radial shortening and articular step,using SPSS21.0 statistics software,Q analysis and comparison group value test for statistical analysis of variance,there was no significant difference between the two groups after operation and 3 months follow-up after operation compared by comparing palmar tilt,articular surface collapse,ulnar deviation(P>0.05).But there was statistical significance in radial shortening difference,(P<0.05).The results suggested that the effect difference between the two methods for palm inclination,ulnar deflection,Radius height reduction was not significant,but locking compression plate internal fixation operation under direct vision for fracture reduction was more conducive to the realization of anatomical reduction or close to anatomical reduction,was conducive to the restoration of the surface of the distal radius of the flat.According to the Gartland-Werly standard for evaluation:3 months follow-up after operation:In Group A,excellent curative effect:22 cases;good:11 cases,ordinary:7.cases and the excellent rate was 82.5%.In Group B,excellent:20 cases,good:4.cases,ordinary:18cases,and the excellent rate was61.5%,there was statistical significance between the two groups(P<0.05).6 months follow-up after operation: In Group A,excellent curative effect:33 cases;good:4 cases,ordinary:3.cases and the excellent rate was 92.5%.In Group B,excellent:30 cases,good:4cases,ordinary:5 cases,and the excellent rate was87.1 %,there was no significant difference between the two groups(P>0.05).the locking plate group is superior to the external Fixator group,which is firmly fixed and stable with locking plate and screws,the patients can be related to early functional exercise after operation,and the wrist need to be braked and the function exercise can not be performed in the early stage when the distal radius fracture is fixed.The effect of joint functional recovery,with most of the external fixator fixed in the later period of time through active functional exercise,after 6 months of follow-up,the two groups of joint functional score improved.Conclusion:Locking compression plate limited incision internal fixation,compared to the closed reduction of external fixator fixed,the articular surface reduction is more ideal,fixed more firmly,allows early wrist joint functional exercise,is conducive to joint functional recovery,is the ideal choice for the current treatment of distal radius C2 fracture. |
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