摘要： 目的 探讨微创手术联合单臂外固定架在桡骨远端粉碎性骨折中的临床应用效果。方法 将40例桡骨远端骨折患者，按治疗方法不同分为对照组（n=20）和观察组（n=20）。对照组给予切开复位钢板内固定治疗，观察组给予微创手术联合单臂外固定架治疗。比较2组术后关节面复位、手术指标、Dienst功能、不良反应等情况。结果 观察组的手术时间、住院时间较对照组缩短，住院费用低于对照组（P<0.05）。术后6个月2组比较，掌倾角、尺偏角、桡骨短缩、关节面间隙、关节面台阶无统计学差异（P>0.05）。术后12个月2组比较，Dienst功能无统计学差异（P>0.05）。与术前比较，术后6个月2组患者血清骨钙素、骨源性碱性磷酸酶水平升高，且观察组高于对照组（P<0.05）；2组患者血清白细胞介素-1、白细胞介素-6水平降低，且观察组低于对照组（P<0.05）。观察组不良反应发生率为15.00%，对照组不良反应发生率为10.00%，无统计学差异（P>0.05）。结论 微创手术联合单臂外固定架治疗桡骨远端粉碎性骨折能够缩短患者手术时间和住院时间，并能够降低炎性细胞因子水平、促进愈合指标的表达，但骨折愈合和关节功能恢复情况与单纯切开复位钢板内固定相比无明显差异。

微创手术联合单臂外固定架在桡骨远端粉碎性骨折中的临床应用

姚恩洋¹, 田野²

1. 中国医科大学附属盛京医院手足踝显微外科, 沈阳 110004;
2. 中国医科大学附属盛京医院脊柱关节外科, 沈阳 110004

收稿日期:2019-12-30出版日期:2020-05-30发布日期:2020-05-13
通讯作者:田野E-mail:tiany3@sj-hospital.org
作者简介:姚恩洋(1987-),男,医师,硕士.
基金资助:国家自然科学基金（81970760）


关键词: 桡骨远端, 粉碎性骨折, 外固定架, 微创手术, 愈合
Abstract: Objective To explore the clinical application of minimally invasive surgery combined with a single arm external fixator for comminuted distal radius fractures. Methods A total of 40 patients with distal radius fractures were divided into control and observation groups(n=20 in each group). The control group was treated with an open reduction and internal fixation,while the observation group underwent minimally invasive surgery combined with a single arm external fixation. The reduction of articular surface,operative indexes,Dienst function,and adverse reactions were compared between the two groups. Results Compared with the control group,the operation and hospitalization times were shorter,and the hospitalization cost was lower in the observation group(P<0.05). Six months postoperatively,there were no significant differences in the palm angle,ulnar angle,radius shortening,articular surface space,and articular surface step between the two groups(P>0.05). There was no significant difference in the Dienst function between the two groups 12 months postoperatively(P>0.05). The serum levels of bone gla protein(BGP) and bone alkaline phosphatase(BALP) increased and the serum levels of interleukin(IL)-1 and IL-6 decreased 6 months postoperatively in the two groups. Compared with the control group, the levels of BGP and BALP were higher and the levels of IL-1 and IL-6 were lower in the observation group(P<0.05). No significant difference in the incidence of adverse reactions was found between the two groups(P>0.05). Conclusion Minimally invasive surgery combined with a single arm external fixator could shorten the operation and hospitalization times,reduce the inflammatory factor levels, and promote the expression of healing indexes in patients with comminuted distal radius fractures.
Key words: distal radius, comminuted fracture, external fixator, minimally invasive surgery, healing
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