腕关节外固定支架联合断端植骨治疗桡骨远端C型骨折的疗效分析
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摘要
背景:桡骨远端C型骨折的手术方式选择存在争论,腕关节外固定支架适用于桡骨远端粉碎性骨折。目的:探讨采用腕关节外固定支架联合断端植骨治疗桡骨远端C型骨折的临床疗效。方法:2011年1月至2017年1月采用腕关节外固定支架联合断端植骨治疗桡骨远端C型骨折46例,男24例,女22例;年龄27～82岁,平均年龄(43.5±12.1)岁。骨折按AO分型,C2型12例,C3型34例。结果:全部患者均获得随访,随访时间为1.0～1.5年,平均(1.2±0.2)年。骨折愈合时间为6～8周,平均(6.5±0.2)周。参照Dienst功能评估标准评定疗效,46例中优30例,良11例,一般4例,差1例,优良率为89.1%。结论:采用腕关节外固定支架联合断端植骨治疗桡骨远端C2、C3型骨折,复位理想,固定可靠,桡骨关节面恢复平整,腕及手部功能恢复满意。
Background: The choice of operative fixation for type C distal radius fractures is controversial. External wrist fixator is suitable for complex comminuted distal radius fractures. Objective: To investigate the clinical effect of external wrist fixator combined with bone grafting on distal radius type C fracture. Methods: From January 2011 to January 2017, A total of 46 patients with distal radius type C fractures were treated with external wrist fixator and broken end bone grafting including 24 males and 22 females, ranging from 27 to 82 years old, with an average age of(43.5±12.1) years. According to AO classification of fracture, there were 12 patients of type C2 and 34 patients of type C3. Results: All patients were followed up for 1.0 to 1.5 years, with an average of(1.2±0.2) years. Fracture healing time was 6 to 8 weeks, with an average of(6.5±0.2) weeks. According to the Dienst function evaluation criteria, there were 30 patients of the excellent, 11 patients of the good, 4 patients in general, 1 patient of the poor, and the excellent and good rate was 89.1%. Conclusions: External wrist fixation combined with bone grafting at broken end is effective in the treatment of distal radius fractures of C2 and C3 with the advantages of satisfactory reduction of fracture, reliable fixation, smooth articular surface of radius and the satisfactory function of wrist and hand.
Background: The choice of operative fixation for type C distal radius fractures is controversial. External wrist fixator is suitable for complex comminuted distal radius fractures. Objective: To investigate the clinical effect of external wrist fixator combined with bone grafting on distal radius type C fracture. Methods: From January 2011 to January 2017, A total of 46 patients with distal radius type C fractures were treated with external wrist fixator and broken end bone grafting including 24 males and 22 females, ranging from 27 to 82 years old, with an average age of(43.5±12.1) years. According to AO classification of fracture, there were 12 patients of type C2 and 34 patients of type C3. Results: All patients were followed up for 1.0 to 1.5 years, with an average of(1.2±0.2) years. Fracture healing time was 6 to 8 weeks, with an average of(6.5±0.2) weeks. According to the Dienst function evaluation criteria, there were 30 patients of the excellent, 11 patients of the good, 4 patients in general, 1 patient of the poor, and the excellent and good rate was 89.1%. Conclusions: External wrist fixation combined with bone grafting at broken end is effective in the treatment of distal radius fractures of C2 and C3 with the advantages of satisfactory reduction of fracture, reliable fixation, smooth articular surface of radius and the satisfactory function of wrist and hand.
引文
[1]唐佩福,王岩,卢世璧,主译.坎贝尔骨科手术学.第13版.北京:北京大学医学出版社,2018:2816-2817.
[2]荣国威,翟桂华,刘沂,等译.骨科内固定.第3版.北京:人民卫生出版社,1995:96-97.
[3]张恒富,蒋明华.老年C3型桡骨远端骨折两种手术治疗方法疗效观察.海南医学,2012,25(6):499-501.
[4]Young BT,Rayan GM.Outcome following nonoperative treatment of displaced distal radius fractures in lowdemand patients older than 60 years.J Hand Surg Am,2000,25(1):l9-28.
[5]Dienst M,Wozasek GE,Seligson D.Dynamic extemal fixation for distal radius fractures.Clin Orthop Relat Res,1997,(338):160-171.
[6]姜新华,禹宝庆,王永安,等.掌侧柱锁定接骨板治疗桡骨远端C型骨折的疗效分析.中华骨与关节外科杂志,2015,8(2):157-160.
[7]Wadsten MA,Sayed-Noor AS,Englund E,et al.Cortical comminution in distal radial fractures can predict the radiological outcome.Bone Joint J,2014,96-B(7):978-983.
[8]刘海涛.DVR解剖型掌侧锁定接骨板治疗C型桡骨远端骨折的临床疗效.中华骨与关节外科杂志,2016,9(3):237-240.
[9]裴国献,李旭,夏志敏,译.创伤骨科手术学.济南:山东科学技术出版社,2012:373-375.
[10]顾新,马德培,杨波,等.桡骨远端骨折外固定术后桡骨缩短原因分析.现代中西医结合杂志,2015,24(19):2112-2114.
[11]Kapoor H,Agarwal A,Dhaon BK.Displaced intra-articular fractures of distal radius:a comparativs evluation of results following closed reduction,external fixation and open reduction with internal fixation.Injury,2000,31(2):75-79.
[12]王云华.桡骨远端粉碎性骨折外固定支架治疗的临床观察.浙江创伤外科,2016,2(5):896-897.
[13]张力人,汤瑞新,程银树.动力型外固定支架治疗桡骨远端粉碎性骨折37例分析.安徽医药,2011,15(6):733-734.
[14]于金河,李增炎,彭阿钦,等.桡骨短缩对桡腕关节影响的生物力学研究.中国临床解剖学杂志,2005,23(1):103-105.
[15]Kopylov P,Johnell O,Redlund-Johnell I,et al.Fractures of the distal ead of the radius in young adults:a 30 year follow up.J Hand Surg Br,1993,18(1):45-49.
[16]陈华,郭晓山,李彬,等.外固定支架加有限内固定治疗青壮年桡骨远端粉碎性骨折.中华创伤骨科杂志,2007,9(5):405-407.
[17]王春昕,赵颖,郑爽,等.T型锁定接骨板治疗老年桡骨远端不稳定性骨折的临床疗效.现代生物医学进展,2015,15(34):6668-6670.
[18]Batra S,Cupta A.The effect of fracture-related factors on the functional outcome at 1 year in distal radius fractures.Injury,2002,33(6):499-502.
[19]Fu YC,Chien SH,Huang PJ,et al.Use of an external fixation combined with the buttress-maintain pinning method in treating comminuted distal radius fractures in osteoporotic patients.J Trauma,2006,60(2):330.
[20]Bartl C,Stengel D,Bruckner T,et al.The treatment of displaced intra-articular distal radius fractures in elderly patients.Send to Dtsch Arztebl Int,2014,111(46):779-787.
[21]华俊,刘栋,苏朋,等.外固定架结合LCP治疗桡骨远端C型骨折.中国骨与关节损伤杂志,2014,29(7):1119-1121.
[22]许真,陈新平.单臂多功能外固定支架治疗桡骨远端粉碎性骨折32例.南昌大学学报(医学版),2013,53(9):68-70.
[2]荣国威,翟桂华,刘沂,等译.骨科内固定.第3版.北京:人民卫生出版社,1995:96-97.
[3]张恒富,蒋明华.老年C3型桡骨远端骨折两种手术治疗方法疗效观察.海南医学,2012,25(6):499-501.
[4]Young BT,Rayan GM.Outcome following nonoperative treatment of displaced distal radius fractures in lowdemand patients older than 60 years.J Hand Surg Am,2000,25(1):l9-28.
[5]Dienst M,Wozasek GE,Seligson D.Dynamic extemal fixation for distal radius fractures.Clin Orthop Relat Res,1997,(338):160-171.
[6]姜新华,禹宝庆,王永安,等.掌侧柱锁定接骨板治疗桡骨远端C型骨折的疗效分析.中华骨与关节外科杂志,2015,8(2):157-160.
[7]Wadsten MA,Sayed-Noor AS,Englund E,et al.Cortical comminution in distal radial fractures can predict the radiological outcome.Bone Joint J,2014,96-B(7):978-983.
[8]刘海涛.DVR解剖型掌侧锁定接骨板治疗C型桡骨远端骨折的临床疗效.中华骨与关节外科杂志,2016,9(3):237-240.
[9]裴国献,李旭,夏志敏,译.创伤骨科手术学.济南:山东科学技术出版社,2012:373-375.
[10]顾新,马德培,杨波,等.桡骨远端骨折外固定术后桡骨缩短原因分析.现代中西医结合杂志,2015,24(19):2112-2114.
[11]Kapoor H,Agarwal A,Dhaon BK.Displaced intra-articular fractures of distal radius:a comparativs evluation of results following closed reduction,external fixation and open reduction with internal fixation.Injury,2000,31(2):75-79.
[12]王云华.桡骨远端粉碎性骨折外固定支架治疗的临床观察.浙江创伤外科,2016,2(5):896-897.
[13]张力人,汤瑞新,程银树.动力型外固定支架治疗桡骨远端粉碎性骨折37例分析.安徽医药,2011,15(6):733-734.
[14]于金河,李增炎,彭阿钦,等.桡骨短缩对桡腕关节影响的生物力学研究.中国临床解剖学杂志,2005,23(1):103-105.
[15]Kopylov P,Johnell O,Redlund-Johnell I,et al.Fractures of the distal ead of the radius in young adults:a 30 year follow up.J Hand Surg Br,1993,18(1):45-49.
[16]陈华,郭晓山,李彬,等.外固定支架加有限内固定治疗青壮年桡骨远端粉碎性骨折.中华创伤骨科杂志,2007,9(5):405-407.
[17]王春昕,赵颖,郑爽,等.T型锁定接骨板治疗老年桡骨远端不稳定性骨折的临床疗效.现代生物医学进展,2015,15(34):6668-6670.
[18]Batra S,Cupta A.The effect of fracture-related factors on the functional outcome at 1 year in distal radius fractures.Injury,2002,33(6):499-502.
[19]Fu YC,Chien SH,Huang PJ,et al.Use of an external fixation combined with the buttress-maintain pinning method in treating comminuted distal radius fractures in osteoporotic patients.J Trauma,2006,60(2):330.
[20]Bartl C,Stengel D,Bruckner T,et al.The treatment of displaced intra-articular distal radius fractures in elderly patients.Send to Dtsch Arztebl Int,2014,111(46):779-787.
[21]华俊,刘栋,苏朋,等.外固定架结合LCP治疗桡骨远端C型骨折.中国骨与关节损伤杂志,2014,29(7):1119-1121.
[22]许真,陈新平.单臂多功能外固定支架治疗桡骨远端粉碎性骨折32例.南昌大学学报(医学版),2013,53(9):68-70.