桡骨远端掌侧钢板螺钉固定方向对关节面稳定性的影响

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摘要目的桡骨远端锁定钢板是桡骨远端经关节面骨折公认有效的治疗方法，但随着万向螺钉的出现，远端螺钉置入方向与其所能提供的支撑效果之间的关系缺少足够重视，本研究旨在探讨远端螺钉置入方向对腕关节功能的影响。方法本研究采用临床随机对照试验方式，纳入100例C型桡骨远端骨折随机分为A组和B组，每组各50例。采用SF-36评分、PRWE评分、DASH评分作为评价指标。A组垂直桡骨干方向排布桡骨远端锁定螺钉，B组按照掌倾角方向平行关节面置入远端螺钉。随访时间为术后2周、3个月、12个月。3次重复测量减少偏倚。计数资料采用person χ²分析检验，方差齐的计量资料组采用两组独立样本 t 检验，方差不齐的采用u检验，α值取双尾0.05。结果 100例均按照试验设计进行手术，术前组间一般情况差异无统计学意义。术后并发症组间差异无统计学意义。术后2周、3个月、12个月SF36评分、DASH评分、PRWE评分差异没有统计学意义。对14例严重骨质疏松出现腕关节解剖角度异常患者进行亚组分析，术后12个月的SF-36评分A组为(36.4±12.8)分、B组为(56.4±20.0)分，差异有统计学意义；术后3个月、12个月的DASH评分组间差异有统计学意义；术后3个月、12个月的PRWE评分差异有统计学意义。结论掌侧万向锁定钢板治疗C型桡骨远端骨折，能提高手术自由度，疗效确切，螺钉锁定的方向影响支撑强度。腕关节对线畸形与关节功能不相关，但合并严重骨质疏松者即使术中解剖复位，关节面再塌陷概率依然较高，建议尽可能平行关节面竹排样支撑置入远端螺钉，以便获得更好的腕关节功能。

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关键词 ：桡骨远端骨折, 掌侧锁定钢板, 万向锁定, DASH评分

Abstract：Objective Volar locking plate is recognized as an effective instrument for distal radius fractures.But different direction of the screw for multidirectional lock provide varying degree of support.Our study aim to discuss the relationship between the fuction of the wrist joint and the distal multidirectional locking screw direction. Methods The random control trial were used.100 patients with distal radius fractures type C were divided into toe groups (50 patients each).SF-36 score PatientRated Wrist Evaluation (PRWE) score and Disability of Arm Shoulder and Hand (DASH) score were used as assess index system.All the distal screw were parallel on horizontal plane，and were perpendicular to radial diaphysis in group A on sagittal plane and were parallel to wrist joint surface of radius in group B on sagittal plane.The follow up from the pro-operation to the 2nd week，3rd month and 12th month after operation.The enumeration data were analyzed using the Chi-square test and the measurement data were statistically treated using t test with a two-sided significance level of 0.05.Results All the 100 patient were followed as the study design.The postoperative complications between groups show no statistical difference.The SF-36 score，the DASH score and the PRWE score in every time point are not significant different.But the subgroup analysis of serious osteoporosis on the 12th month post operation showed significant difference，on the 3rd month the DASH score and the PRWE score were significantly different.Conclusion The distal multidirection design give the surgeon more freedom during the operation.The screw direction affect the supporting strength.The radiological alignment have little relationship with the wrist joint function.Serious osteoporosis show great probability of radiological alignment failure.Parallel distal screws parallel to wrist joint surface of radius were recommend to get better joint function.

Key words： distal radius fracture volar locking plate multidirectional locking disability of arm shoulder and hand scroe

通讯作者: 郑龙坡

作者简介: 唐健民(1971－ )，男，副主任医师，江苏省泰州市第三人民医院骨科，225321。

引用本文:

唐健民 1，郑龙坡 2*. 桡骨远端掌侧钢板螺钉固定方向对关节面稳定性的影响[J]. 实用骨科杂志, 2017, 23(9): 798-810.
Tang Jianmin 1 Zheng Longpo 2*. Stabilisation of Volar Locking Plate for Distal Radius Fractures with Different Direction of the Screw. sygkzz, 2017, 23(9): 798-810.

链接本文:

http://www.sygkzz.com/CN/ 或 http://www.sygkzz.com/CN/Y2017/V23/I9/798

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