目的：探讨钢板结合外固定支架与闭合复位克氏针结合外固定支架治疗桡骨远端C型粉碎性骨折的疗效。方法：背侧钢板结合外固定支架（B组）35例，用1～2块微型钢板固定桡骨远端，同时应用外固定架撑开固定于桡骨和第二掌骨。闭合复位克氏针结合外固定支架（A组）27例，采用闭合手法复位，克氏针固定骨折断端，然后用外固定架撑开固定于桡骨和第二掌骨。结果：术后B组随访12～34个月，平均随访15．2个月，A组随访10～32个月，平均随访14．6个月。X线提示：两组骨折全部愈合良好。B组患者的尺偏角、掌倾角及Gartland‐Wetley评分均明显优于A组，差异有统计学意义（P＜0．05）。两组患者在满意度上差异无统计学意义（P＞0．05）。结论：背侧钢板结合外固定支架治疗桡骨远端C型粉碎性骨折的疗效优于闭合复位克氏针结合外固定支架，但背侧钢板固定手术复杂、手术费用较高、伤口局部创伤较大、需要二次住院手术去除内固定钢板，两组在患者满意度上差异无统计学意义，因此临床治疗中需要依据患者具体受伤情况选用合适的手术方式。%Objective :To compare the clinical effects of the combination of plate and external fixation and surgery for the external fixation of the Gram’s needle in the treatment of AO type C distal radial fractures .Methods :The combina‐tion of plate and external fixation of 35 patients(group B) .Fixation of distal radius with two pieces of mini plate ,at the same time the application of external fixator distraction on the radius and the second metacarpal .The Closed manipula‐tive reduction for the external fixation of the Gram’s needle of 27 patients(group A) .Closed manipulative reduction , Gram’s needle fixation fracture ,then use the external fixator distraction on the radius and the second metacarpal .Re‐sults:Postoperatively patients in the group B was follow‐up for 12~34 months ,with an average of 15 .2 months .The group A was follow‐up for an average of 14 .6 months ranging from 10~32 months .X‐rays showed fractures in both groups all healed .The ulnar deviation ,radial height and Gardand‐Werley score were significantly better in the group B than the group A(P<0 .05) .Conclusion:Treatment outcomes of the combination of plate and external fixation group are better than that of the external fixation of the Gram’s needle group of type C distal radial dorsal comminuted frac‐tures .However it is a more complex surgery .costs more and requires a secondary surgery to remove the hard wares . Patients’satisfaction is not much different .The choices of treatment method depend on the patients’clinical conditions .
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