掌侧加压锁定钢板结合外固定架治疗易移位C3型桡骨远端骨折
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摘要
目的:探讨掌侧加压锁定钢板结合外固定架治疗易移位C3型桡骨远端骨折的疗效。方法:2012年6月~2014年6月,采用掌侧加压锁定钢板结合外固定架治疗易移位C3型桡骨远端骨折11例。其中男5例,女6例;年龄25~74岁,平均(55.5±10.2)岁。术后3~6周去除外固定架,随访记录骨折愈合时间及掌倾角、尺偏角、桡骨高度及腕关节活动情况。末次随访时根据改良的Gartland-Werley评分标准评定疗效。结果:11例均获随访,随访时间12~24个月,平均(16.0±3.6)个月。术后切口均Ⅰ期愈合,无伤口或钉道感染及皮肤坏死等早期并发症,但有1例病人出现切口周围复杂性局部疼痛综合征(CRPS)。X线片复查示骨折均愈合,愈合时间8~12周,平均(10.3±1.3)周;末次随访无骨折移位,关节面轮廓良好、无塌陷,桡骨未见明显短缩等。掌倾角6~15°,平均(10.4±4.3)°;尺偏角18~25°,平均(20.8±4.2)°。腕关节背伸、屈曲、桡偏、尺偏、旋前、旋后功能良好。根据改良的Gartland and Werley评分标准评价腕关节功能,获优5例,良4例,一般2例,优良率为82%。结论:对于易移位C3型桡骨远端骨折,掌侧加压锁定钢板结合外固定架可较好维持骨折复位,可获良好的腕关节功能。
Objective: To assess the clinical effectiveness of volar locking compression plate with external fixation in the treatment of type C3 distal radius fractures.Methods: Eleven patients[5 males,6 females,age ranged from 25 to 74 years,mean( 55.5±10.2) years]with type C3 distal radius fractures were treated with volar locking compression plate with external fixation between June of 2012 and 2014.The external fixation was removed in 3 to 6 weeks following surgery.In the follow-up periods,all patients were observed and recorded on the time of fracture healing,palmar tilt,radial inclination,radial height and wrist function.By the final follow-up,the function was evaluated according to the scoring system of Gartland and Werley.Results: The 11 patients were followed up from 12 to 24 months,with an average of( 16.0±3.6) months.Primary healing of the incision was noted in all patients.No complications of incision and pin track infection as well as necrosis occurred,yet complex regional pain syndrome was found in one patient.Postoperative X-ray examination indicated fully healed fractures in 8 to 12 weeks[mean( 10.3±1.3) weeks].Final follow-up showed no loss of reduction,joint surface subsidence and shortening of the radius,and that the mean palmar tilt angle was between 6° and 15°[mean( 10.4±4.3) ° ],and the mean radial inclination angle between 18°and 25°[mean( 20.8±4.2) °].Flexion and extension,radial deviation,ulna deviation,pronatio and supination were in good function.By the scoring system of Gartland and Werley,5 cases were in excellent recovery( 82%),good in 4 and fair in 2.Conclusion: Volar locking compression plate and external fixation can lead to normal reconstruction of the anatomic structures and good wrist function in patients with type C3 distal radius fractures.
Objective: To assess the clinical effectiveness of volar locking compression plate with external fixation in the treatment of type C3 distal radius fractures.Methods: Eleven patients[5 males,6 females,age ranged from 25 to 74 years,mean( 55.5±10.2) years]with type C3 distal radius fractures were treated with volar locking compression plate with external fixation between June of 2012 and 2014.The external fixation was removed in 3 to 6 weeks following surgery.In the follow-up periods,all patients were observed and recorded on the time of fracture healing,palmar tilt,radial inclination,radial height and wrist function.By the final follow-up,the function was evaluated according to the scoring system of Gartland and Werley.Results: The 11 patients were followed up from 12 to 24 months,with an average of( 16.0±3.6) months.Primary healing of the incision was noted in all patients.No complications of incision and pin track infection as well as necrosis occurred,yet complex regional pain syndrome was found in one patient.Postoperative X-ray examination indicated fully healed fractures in 8 to 12 weeks[mean( 10.3±1.3) weeks].Final follow-up showed no loss of reduction,joint surface subsidence and shortening of the radius,and that the mean palmar tilt angle was between 6° and 15°[mean( 10.4±4.3) ° ],and the mean radial inclination angle between 18°and 25°[mean( 20.8±4.2) °].Flexion and extension,radial deviation,ulna deviation,pronatio and supination were in good function.By the scoring system of Gartland and Werley,5 cases were in excellent recovery( 82%),good in 4 and fair in 2.Conclusion: Volar locking compression plate and external fixation can lead to normal reconstruction of the anatomic structures and good wrist function in patients with type C3 distal radius fractures.
引文
[1]GEHRMANN SV,WINDOLF J,KAUFMANN RA,et al.Distal radius fracture management in elderly patients:a literature review[J].J Hand Surg Am,2008,33(3):421-429.
[2]WRIGHT TW,HORODYSKI M,SMITH DW.Functional outcome of unstable distal radius fractures:ORIF with a volar fixed-angle tine plate versus external fixation[J].J Hand Surg Am,2005,30(2):289-299.
[3]OSHIGE T,SAKAI A,ZENKE Y,et al.A comparative study of clinical and radiological outcomes of dorsally angulated,unstable distal radius fractures in elderly patients:intrafocal pinning versus volar locking plating[J].J Hand Surg Am,2007,32(9):1385-1392.
[4]曾林如,汤样华,徐灿达,等.解剖锁定钢板治疗C3型桡骨远端骨折[J].中华外科杂志,2014,30(3):226-228.
[5]ARO H,KOIVUNEN T.Minor axial shortening of the radius affects outcome of colles'fracture treatment[J].J Hand Surg Am,1991,16(3):392-398.
[6]PROTOPSALTIS TS,RUCH DS.Volar approach to distal radius fractures[J].Hand Surg Am,2008,33(6):958-965.
[7]ORBAY J.Volar plate fixation of distal radius fractures[J].Hand Clin,2005,21(3):347-354.
[8]HABERLE S,SANDMANN GH,DEILER S,et al.Pronator quadratus repair after volar plating of distal radius fractures or not?Results of a prospective randomized trial[J].Eur J Med Res,2015,20(1):93.
[9]SARMIENTO A,PRATT GW,BERRY NC,et al.Colles'fractures,Functional bracing in supination[J].J Bone Joint Surg Am,1975,57(3):311-317.
[10]杜晓龙,欧学海,许玉本,等.背侧人路双微型锁定钢板治疗桡骨远端骨折(B3、C2、C3型)疗效分析[J].中华外科杂志,2013,29(5):266-267.
[11]RIKLI DA,REGAZZONI P.Fractures of the distal end of the radius treated by internal fixation and early function.A preliminary report of 20 cases[J].J Bone Joint Surg Br,1996,78(4):588-592.
[12]VON RJ,MATSCHKE S,JUPITER JB,et al.Characteristics of two different locking compression plates in the volar fixation of complex articular distal radius fractures[J].Bone Joint Res,2012,1(6):111-117.
[13]STANBURY SJ,SALO A,ELFAR JC.Biomechanical analysis of a volar variable-angle locking plate:the efffect of capturing a distal raduis styloid Fragment[J].J Hand Surg Am,2012,37(12):2488-2494.
[14]姜宗圆,马涛,夏江,等.蝶形锁定钢板在复杂桡骨远端骨折中的应用[J].中国修复重建外科杂志,2014,28(6):665-668.
[15]王觅格,李炳楠,陈跃忠,等.掌侧入路切开复位万向锁定钢板内固定治疗桡骨远端粉碎性骨折[J].中华创伤骨科杂志,2015,17(1):87-89.
[16]GELLER L,BERNSTEIN M,CARLI A,et al.Efficacy of different fixation devices in maintaining an initial reduction for surgically managed distal radius fractures[J].Canadian Journal of Surgery Journal Canadien De Chirurgie,2009,52(5):161-166.
[17]GU WL,WANG J,LI DQ,et al.Bridging external fixation versus non-bridging external fixation for unstable distal radius fractures:A systematic review and meta-analysis[J].J Orthop Sci,2016,21(1):24-31.
[18]KREDER HJ,HANEL DP,AGEL J,et al.Indirect reduction and percutaneous fixation versus open reduction and internal fixation for displaced intra-articular fractures of the distal radius:a randomised,controlled trial[J].J Bone Joint Surg Br,2005,87(6):829-836.
[2]WRIGHT TW,HORODYSKI M,SMITH DW.Functional outcome of unstable distal radius fractures:ORIF with a volar fixed-angle tine plate versus external fixation[J].J Hand Surg Am,2005,30(2):289-299.
[3]OSHIGE T,SAKAI A,ZENKE Y,et al.A comparative study of clinical and radiological outcomes of dorsally angulated,unstable distal radius fractures in elderly patients:intrafocal pinning versus volar locking plating[J].J Hand Surg Am,2007,32(9):1385-1392.
[4]曾林如,汤样华,徐灿达,等.解剖锁定钢板治疗C3型桡骨远端骨折[J].中华外科杂志,2014,30(3):226-228.
[5]ARO H,KOIVUNEN T.Minor axial shortening of the radius affects outcome of colles'fracture treatment[J].J Hand Surg Am,1991,16(3):392-398.
[6]PROTOPSALTIS TS,RUCH DS.Volar approach to distal radius fractures[J].Hand Surg Am,2008,33(6):958-965.
[7]ORBAY J.Volar plate fixation of distal radius fractures[J].Hand Clin,2005,21(3):347-354.
[8]HABERLE S,SANDMANN GH,DEILER S,et al.Pronator quadratus repair after volar plating of distal radius fractures or not?Results of a prospective randomized trial[J].Eur J Med Res,2015,20(1):93.
[9]SARMIENTO A,PRATT GW,BERRY NC,et al.Colles'fractures,Functional bracing in supination[J].J Bone Joint Surg Am,1975,57(3):311-317.
[10]杜晓龙,欧学海,许玉本,等.背侧人路双微型锁定钢板治疗桡骨远端骨折(B3、C2、C3型)疗效分析[J].中华外科杂志,2013,29(5):266-267.
[11]RIKLI DA,REGAZZONI P.Fractures of the distal end of the radius treated by internal fixation and early function.A preliminary report of 20 cases[J].J Bone Joint Surg Br,1996,78(4):588-592.
[12]VON RJ,MATSCHKE S,JUPITER JB,et al.Characteristics of two different locking compression plates in the volar fixation of complex articular distal radius fractures[J].Bone Joint Res,2012,1(6):111-117.
[13]STANBURY SJ,SALO A,ELFAR JC.Biomechanical analysis of a volar variable-angle locking plate:the efffect of capturing a distal raduis styloid Fragment[J].J Hand Surg Am,2012,37(12):2488-2494.
[14]姜宗圆,马涛,夏江,等.蝶形锁定钢板在复杂桡骨远端骨折中的应用[J].中国修复重建外科杂志,2014,28(6):665-668.
[15]王觅格,李炳楠,陈跃忠,等.掌侧入路切开复位万向锁定钢板内固定治疗桡骨远端粉碎性骨折[J].中华创伤骨科杂志,2015,17(1):87-89.
[16]GELLER L,BERNSTEIN M,CARLI A,et al.Efficacy of different fixation devices in maintaining an initial reduction for surgically managed distal radius fractures[J].Canadian Journal of Surgery Journal Canadien De Chirurgie,2009,52(5):161-166.
[17]GU WL,WANG J,LI DQ,et al.Bridging external fixation versus non-bridging external fixation for unstable distal radius fractures:A systematic review and meta-analysis[J].J Orthop Sci,2016,21(1):24-31.
[18]KREDER HJ,HANEL DP,AGEL J,et al.Indirect reduction and percutaneous fixation versus open reduction and internal fixation for displaced intra-articular fractures of the distal radius:a randomised,controlled trial[J].J Bone Joint Surg Br,2005,87(6):829-836.
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