标题：不同临床分型桡骨远端Die-punch骨折近远期预后比较

      作者：曹峰 1，江波 2，吴晓东 1，盛鹏 1，仓挺松 1，朱寅 1，陈阳 1，吴骏 1    (1.苏州市中西医结合医院骨一科，江苏 苏州 215101；2.苏州大学第二附属医院，江苏 苏州 215000)

      卷次： 2017年28卷18期

      【摘要】 目的 探讨不同临床分型桡骨远端Die-punch骨折锁定钢板治疗后近远期疗效。方法 选取2009年1月至2015年6月共99例桡骨远端Die-punch骨折患者为研究对象，分为掌侧型组33例、劈裂型组33例、塌陷型组33例，均予掌侧切口，根据骨折移位情况复位，骨折粉碎明显者植骨，并锁定钢板内固定治疗，治疗后进行Colles骨折评估、手术时间等指标和并发症比较。结果 三组手术时间、术中出血量、住院时间、切口长度比较差异无统计学意义(P>0.05)；塌陷型组术后6个月、12个月疼痛评分分别为(21.19±3.51)分、(22.14±3.49)分，均低于其他两组，但差异无统计学意义(P>0.05)；三组组内术后6个月、术后12个月疼痛、活动、握力、畸形、尺偏角、桡骨长度、掌倾角评分比较差异均无统计学意义(P>0.05)，术后6个月、术后12个月三组间以上指标比较差异均无统计学意义(P>0.05)；并发症上，掌侧型组为18.18%，劈裂型组为18.18%，塌陷型组为45.45%，塌陷型组显著高于其他两组，差异有统计学意义(P<0.05)。结论 锁定钢板切开复位内固定治疗桡骨远端Die-punch骨折掌侧型、劈裂型、塌陷型近远期效果相近，但塌陷型在创伤性关节炎、关节僵硬并发症上较高。
      【关键词】 桡骨远端Die-punch骨折；掌侧型；劈裂型；塌陷型；疗效
      【中图分类号】 R683.41 【文献标识码】 A 【文章编号】 1003—6350（2017）18—2966—04

Prognosis of different clinical types of distal radius die-punch fractures.
CAO Feng 1, JIANG Bo 2, WU Xiao-dong 1,SHENG Peng 1, CANG Ting-song 1, ZHU Yin 1, CHEN Yang 1, WU Jun 1. 1. Department of Orthopaedics, Suzhou Hospital ofintegrated traditional Chinese and Western medicine, Suzhou 215101, Jiangsu, CHINA; 2. The Second Affiliated Hospital ofsoochow University, Suzhou 215000, Jiangsu, CHINA
【Abstract】 Objective To investigate the short-term and long-term results of different types of distal radiusfractures after die-punch locking plate treatment. Methods A total of 99 cases of distal radius fracture of die-punch,who admitted to our hospital from January 2009 to June 2015, were selected and divided into the volar type group, splittype group, and collapse type group, with 33 cases in each group. The three groups were treated with volar incision;fracture reduction was carried out according to fracture displacement; the obvious bone comminuted fracture patients weretreated with bone graft treatment; locking steel plate fixed treatment was applied in these patients. After the treatment,Colles fracture assessment, operation time and other indicators and complications were compared. Results There nosignificant difference among the three groups in the operation time, amount of bleeding, hospitalization time, incisionlength (P>0.05). The pain scores after 6 months and 12 months of treatment in the collapse type group were respectively(21.19 ± 3.51) and (22.14 ± 3.49), which were lower than that in the other two groups, but there was no significancedifference (P>0.05). There was no significant difference in pain, activity, grip strength, deformity, ulnar angle, radiallength, palm tilt scores after 6 months and 12 months of treatment within the three groups (P>0.05); there also nosignificant difference among the three groups in the above indicators (P>0.05). The postoperative complication of thecollapse type group was 45.45%, which was significantly higher than 18.18% and 18.18% in the split type group and thevolar type group (P<0.05). Conclusion The therapy of locking plate fixation volar incision fracture reduction hassimilar short-term and long-term effect in the treatment of distal radius die-punch fractures of volar type, split type,collapse type, but the collapse type has higher occurrence of traumatic arthritis and joint stiffness.
      【Key words】 Die-punch fracture of the distal radius; Volar type; Split type; Collapse type; Curative effect·论 著·doi:10.3969/j.issn.1003-6350.2017.18.012基金项目：江苏省苏州市科技计划项目(编号：2016B105)