Objective To investigate the correlation of radiocarpal joint morphological characteristics with wrist function after surgical treatment of distal radius fractures.Methods The data of 388 cases of type C distal radial fractures which were treated from January 2006 to December 2013 either by closed reduction and fixation with external fixator combined with limited Kirschner wire fixation,or by open reduction and internal fixation with plate and screws were analyzed.The wrist joint function was evaluated using Dienst functional score,X rays and CT scans.Results When treated with closed reduction and external fixator and K-wire fixation,the excellent outcome rate was 89.16％,89.28％ and 88.57％,respectively,based on Dienst functional score,recovery of radial height and radiocarpal joint surface congruity,and the degree of joint surface stepwise deformity or collapse.When treated with open reduction and internal fixation,the excellent rate was 90.27％,91.01％ and 88.89％,respectively.There were no significant differences between the two treatment groups (P ＞ 0.05).Conclusion The goal of surgical treatment of distal radius fractures is to restore the anatomy of the distal radius articular surface and decrease fracture malunion.External fixator fixation is a less invasive and simpler operation.Even if there is a potential risk of traumatic arthritis due to load redistribution caused by the 1 to 2 mm step in the joint surface,recovery of wrist function can be more desirable with proper functional rehabilitation.%目的 探讨桡骨远端骨折治疗后桡腕关节形态学特征与腕关节功能的相关性.方法 收集自2006年1月至2013年12月行闭合复位外固定支架结合克氏针有限内固定及切开复位钢板螺钉内固定两种方法治疗的C型桡骨远端骨折病例共388例,采用Dienst功能评分、X线片及CT片评价腕关节功能.结果 Dienst功能评分,恢复桡骨高度及恢复桡腕关节面完全平整,关节面不同程度的台阶或塌陷,闭合复位外固定支架结合克氏针有限内固定组优良率分别为89.16％、89.28％及88.57％,而切开复位钢板螺钉内固定组优良率分别为90.27％、91.01％及88.89％.两组间差异无统计学意义(P＞0.05).结论 桡骨远端骨折手术目的在于恢复桡骨远端关节面的解剖形态,降低骨折畸形愈合率,外固定支架具有创伤小、操作简单等优点.即使关节面有1～2mm的台阶,会引起关节面负荷重分布,出现潜在创伤性关节炎的风险,但只要经过正确的功能康复,桡腕关节功能的恢复也可能较为理想.
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