Objective To observe the clinical effect of bone graft combined with oblique T-plate fixation in the treatment of unstable distal radius fractures in the elderly.Methods Eighty elderly patients with unstable distal radius fractures treated in our hospital from Jan.2011 to Jan.2015 were selected,who were randomly divided into study group and control group,with 40 cases in each group.The study group was treated with autogenous bone or allograft bone combined with oblique T-plate internal fixation,while the control group was treated with external fixation.The palmar tilt,ulnar deviation and radial height of the two groups were measured and compared before operation and at 6 months after the operation.Wrist mobility was compared at 6 months postoperatively at the same time.The wrist function was compared according to the Gartland-Werley wrist function score.The clinical effects and complications were compared.Results The 80 patients were followed up for 6-12 months (average,(9.3±3.2) months).There was no significant difference between the two groups in preoperative palmar tilt,ulnar deviation and radius height (P>0.05).At 6 months after operation,the palmar tilt,ulnar deviation and radial height were significantly different from those before the operation(P<0.05),and the change of the study group was obviously higher than the control group (P<0.05).The patients in the study group were significantly better than those in the control group in the aspects of wrist extension,palmar flexion,pronation and supination,and the differences were statistically significant (P<0.05).For B2 type,B3 type,and C1 type fractures,the Gartland-Werley wrist function score was lower than that of the control group,and the difference was statistically significant (P<0.05),but for C2 type and C3 type fractures,the two groups had no significant difference (P>0.05).In clinical curative effect,there were 30 cases of excellent,5 good,4 fair,and 1 poor in study group with the excellent and good rate of 87.5%,while there were 18 cases of excellent,10 good,7 fair,and 5 poor in the control group,with the excellent and good rate of 70%,and the difference was statistically significant between the two groups (P=0.043).With regard to the postoperative complications,the incidence of complications was 10.0% in the study group and 22.5% in the control group.Conclusion Bone graft combined with oblique type T-plate fixation in the treatment of unstable distal radius fractures in the elderly has obviously curative effect,can significantly improve the cure rate of patients,and greatly reduces the incidence of complications.It is worthy to be widely promoted in clinical application.%目的 探究老年桡骨远端不稳定型骨折应用植骨联合斜T型钢板内固定治疗的临床疗效.方法 选取2011年1月~2015年1月诊治的80例老年桡骨远端不稳定型骨折患者作为研究对象,将其分为研究组和对照组,每组各40例,研究组采用自体骨或同种异体骨植骨联合斜T型钢板内固定治疗,对照组采用外固定支架固定治疗.测量并比较两组在术前及术后第6个月掌倾角、尺偏角、桡骨高度,比较术后第6个月腕关节活动度,同时根据腕关节Gartland-Werley功能评分标准进行评定,并对两组患者术后临床效果及并发症进行比较.结果 80例患者术后获6~12个月,平均9.3个月随访.两组患者术前在掌倾角、尺偏角、桡骨高度相比较差异无统计学意义(P>0.05),术后第6个月掌倾角、尺偏角、桡骨高度与术前相比差异具有统计学意义(P<0.05),且研究组变化明显低于对照组(P<0.05).术后第6个月,研究组在腕关节背伸、掌曲、旋前以及旋后均明显优于对照组,差异具有统计学意义(P<0.05).对于B2型、B3型、C1型骨折的患者,其腕关节Gartland-Werley功能评分明显低于对照组,差异具有统计学意义(P<0.05),而对于C2型、C3型骨折,两组比较没有明显的差异(P>0.05).术后临床疗效方面,研究组优30例、良5例、可4例、差1例,总优良率为87.5%;对照组优18例、良10例、可7例、差5例,优良率为70.0%,差异具有统计学意义(P=0.043).两组术后均有不同程度的并发症发生,研究组并发症发生率为10.0%,对照组发生率为22.5%.结论 植骨联合斜T型钢板内固定治疗老年桡骨远端不稳定型骨折疗效显著,可明显提高患者的治愈率,并大大降低了患者并发症的发生率,具有临床应用价值,值得推广.
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