中国骨伤2025，Vol.38Issue(1)：18-24,7.DOI:10.12200/j.issn.1003-0034.20240482
克氏针支撑固定与切开复位接骨板固定治疗中老年Colles骨折的临床疗效观察
Clinical efficacy of open reduction and internal fixation with plates versus minimally invasive Kirschner wire fixation for osteoporotic Colles'fractures
摘要
Abstract
Objective To compare the short-term clinical efficacy and safety of closed reduction with Kirschner wire fixa-tion versus open reduction with plate fixation for treating osteoporotic Colles'fractures in middle-aged and elderly patients.Methods Between January 2018 and January 2023,119 patients with Colles fractures were retrospectively analyzed,including 39 males and 80 females,aged from 48 to 74 years old with an average of(60.58±6.71)years old.The time from injury to oper-ation ranged 1 to 13 days with an average of(5.29±2.52)days.According to the surgical method,they were divided into Kirschner wire fixation group(Kirschner wire group)and plate internal fixation group(plate group).In Kirschner wire group,there were a total of 68 patients,comprising 21 males and 47 females.The average age was(61.15±6.24)years old,ranged from 49 to 74 years old.Among them,41 cases involved the left side while 27 cases involved the right side.In the plate group,there were a total of 51 patients,including 18 males and 33 females.The average age was(59.78±5.71)years old ranged from 48 to 72 years old.Among them,there were 31 cases on the left side and 20 cases on the right side.The following parameters were recorded before and after the operation:operation time,intraoperative blood loss,hospitalization days,hospitalization ex-penses,postoperative complications,and radiographic parameters of distal radius(distal radius height,ulnar deviation angle,palmar tilt angle).The clinical efficacy was evaluated at 3 and 12 months after the operation using Gartland-Werley and dis-abilites of the arm shoulder and hand(DASH)scores.Results The patients in both groups were followed up for a duration from 12 to 19 months with an average of(13.32±2.02)months.The Kirschner wire group exhibited significantly shorter operation time compared to the plate group 27.91(13.00,42.00)min vs 67.52(29.72,105.32)min,Z=-8.74,P=0.00.Intraoperative blood loss was also significantly lower in the Kirschner wire group than in the plate group 3.24(1.08,5.40)ml vs 21.91(17.38,26.44)ml,Z=-9.31,P=0.00.Furthermore,patients in the Kirschner wire group had a shorter length of hospital stay compared to those in the plate group(8.38±2.63)days vs(11.40±2.78)days,t=-3.12,P=0.00.Additionally,hospitalization cost was significantly lower in the Kirschner wire group than in the plate group 10 111.29(6 738.98,13 483.60)yuan vs 15 871.11(11 690.40,20 051.82)yuan,Z=-5.62,P=0.00.The incidence of complications was 2 cases in the Kirschner wire group and 1 case in the plate group,with no statistically significant difference(P＞0.05).At 3 months postoprative,the radial height of the Kirschner wire group was found to be significantly smaller than that of the plate group,with measurements of(1 1.45±1.69)mm and(12.1 1±1.78)mm respectively(t=-2.06,P=0.04).However,there were no statistically significant dif-ferences observed in ulnar deviation angle and palmar tilt angle between the two groups(P＞0.05).The DASH score and Gart-land-Werley score in the Kirschner group were significantly higher than those in the plate group at 3 months post-operation(19.10±9.89)vs(13.47±3.51),t=4.34,P=0.00;(11.15±3.61)vs(6.41±2.75),t=8.13,P=0.00).However,there was no sig-nificant difference between the two groups at 12 months post-operation(P＞0.05).Conclusion Compared to plate internal fixa-tion,closed reduction with Kirschner wire support fixation yields a slightly inferior recovery of radial height;however,there is no significant disparity in the functional score of the affected limb at 12 months post-operation.Nonetheless,this technique offers ad-vantages such as shorter operation time,reduced intraoperative blood loss,decreased hospitalization duration,and lower cost.关键词
骨质疏松/Colles骨折/克氏针/微创固定/接骨板Key words
Osteoporosis/Colles'fractures/Kirschner wire/Minimally invasive fixation/Plate fixation分类
医药卫生引用本文复制引用
张峻玮,成永忠,奚小冰,侯金永,李朝辉,马振元,高祥,毕宏政,陈玲玲,王海涛,聂伟志..克氏针支撑固定与切开复位接骨板固定治疗中老年Colles骨折的临床疗效观察[J].中国骨伤,2025,38(1):18-24,7.基金项目
山东省自然基金面上项目(编号:ZR2020MH358) （编号:ZR2020MH358）
全国基层名老中医专家杨茂清传承工作室建设项目[编号:国中医药人教函(2018)133号] （2018）
全国名老中医药专家杨茂清传承工作室建设项目[编号:国中医药人教函(2022)75号] （2022）
威海市第三批中医重点专科(四肢创伤科)项目[编号:威卫计中医(2017)14号] （四肢创伤科）
威海市中医药科技面上项目(编号:2021N-02)Shandong Provincial Natural Science Foundation General Project(No.ZR2020MH358) （编号:2021N-02）
