切开复位内固定治疗桡骨远端骨折
摘要
桡骨远端骨折是临床上常见的骨折类型,约占全身骨折的20%,在上肢骨折中更为常见,人类对这种骨折的认识已有200多年的历史。自Pouteau在1783年首先描述了这种骨折以来不断有学者进行详细的研究及报道。本文通过文献回顾,分析总结桡骨远端骨折的应用解剖、分型、损伤特点、治疗方法及并发症,着重介绍切开复位内固定治疗桡骨远端骨折的方法。
我院在2005年8月至2007年10月间,对22例骨折患者进行了切开复位内固定治疗,经随访8～24个月,患者功能恢复良好。按照Gartland与Werley临床功能评分标准,优11例,占50%;良4例,占18%;可6例,占27%;差1例,占5%。因此,桡骨远端骨折行切开复位内固定治疗,恢复骨骼正常解剖关系,能够取得良好疗效。
Distal radius fracture is very common in clinical works, which accounts for about 20% of all fractures. And dorsal intra-articular fracture is the most common type. The distal radius fracture is mainly occurred in the 6 to 10-year-old and 60 to 75-year-old phases as previous research statistics, but in recent years, the incidence of this type of fracture in young people increases gradually. Pouteau first described the fracture in 1783, and then scholars at home and abroad started to research the fracture. However, the long-term effect of this type of fracture is still uncertain because it has different injury forms and treatment methods.
The distal radius, the main connected structure of the forearm and wrist, locates superficially and has two physiological angles, which are the ulnar inclination varying from 13°to 30°with the mean 23°and the volar tilt with the angle of 10°to 12°on average. The activity scope of the radiocarpal joint is the biggest, amounting to 140°, and ulnar and radial drift is up to 60°. The distal radial ulnar joint can be rotated by 150°. As for the biomechanics, studies have shown that the radiocarpal joint bears 80% of the axial load.
Most of the distal radius fractures are due to falling with the hand over-stretched or the traffic accidents. Although Extra-articular fracture is the main injured type, comminuted fractures of distal radius are increasing in recent years due to the high-energy trauma. The distal radius is mainly composed by cancellous bone. During fracture the cancellous bone will collapse and then makes radius shortened and the ulnar inclination and volar tilt smaller, so it will produce a serious influence to the radiocarpal joint and distal radial ulnar joint in coordination and rotation.
When choosing method for treatment of the distal radius fracture the classification of fracture and the extent of damage should be considered. For simple, we can choose closed reduction and fixation method to treat stable extra-articular fracture and some intra-articular fracture. If the functional reduction can not be achieved or the location of the reset fracture can not be maintained, surgery is considered.
For the comminuted intra-articular fracture and invalid manipulative reduction cases, open reduction and internal fixation is a very effective means of treatment. It can maximize the restoration of the integrity of joints and provide anatomical basis of functional recovery. It is believed that surgery should be performed when the reduction can not be maintained after manipulative reduction and gypsum fixation. Specific indications include: (1) notable comminuted fractures; (2) a wide range dorsal smash up to 50% or more than diameter metaphysic; (3) displaced intra-articular comminuted fracture; (4) the articular surface shift >2 mm; (5) shortening>10mm; (6) major fracture block’s angle>20°; (7) osteoporosis; (8) age> 60 years old. The progress of open reduction and internal fixation currently is mainly reflected in two aspects which include internal fixation devices and improving of the choice of the operative approach.
At present the internal fixation materials include small "T" plate, screws, pinning, AO"π"-shaped plate, tube-shaped plate, as well as the locking compression plate (locking compression plate, LCP). Choosing suitable fixation material to treat different fractures will make the fractures’fixation and the restoration of joint function satisfying. It is reported that the LCP was used extensively and the results were always very good.
There are three operative approaches which are metacarpal approach, dorsal approach and union approach. We will illustrate the first two approaches in detail as follow. (1) Metacarpal approach: In this approach, the incision will be made at the radialis of the flexor carpi radialis muscle, and the pronator quadratus musle is revealed between the flexor carpi radialis muscle and radial artery. At last the operators will cut the periosteum and the insertion of the pronator quadratus musle at the lateral edge of the radial bone and then expose the fractures. (2)Dorsal approach: During dorsal approach, the incision is usually made between different extensor spacing according to different purposes. Making incision in the interval between the first and second extensor spacing is used to treat the fracture of the radial styloid, while incision in the dorsal of the Lister nodules crossing the 3rd dorsal interval should be made in revealing dorsal radial metaphysis and articular surface fracture. In recent years, it is observed that dorsal plate which is used to treat the distal radial fracture can make extensor tendon abrasion or rupture. Furthermore, dorsal incision often hurts superficial radial nerve and the branch of the radial artery. The branchs of dorsal ulnar nerve are also vulnerable when extending the incision to the dorsoulnar of the wrist. However, the metacarpal approach has small damage to cortical bone and the reset mark is very clear. Contrarily, palm side of the distal radius is very flat. So the setting of plate is easily achieved and the internal fixation is stable. In front of the plate there are pronator quadratus muscle and other soft tissues, so it can reduce the adhesion of soft tissue ,tendon inflammation ,wound infection and the exposure of the plate. Therefore, it tends to choose operative incision in the palm side. If there is bone defect autoallergic ilium graft can be chosen, which can induce bone growth and promote bone healing by providing support for intra-articular fracture. Penning thought that bone graft should be considered under the following circumstances: (1) shortening> 10 mm; (2) ulnaris bone shortening> 5 mm; (3) in patients with osteoporosis.
The merit of operation is that it can make the fracture anatomical reduction, and make normal volar tilt and ulnar inclination recovered. In this way patient may do functional training early, and restore the wrist function as far as possible.
However, the operation still has some inevitable complications. For example, injury of the nerve and tendon, tendon adhesion and ankylosis are the very common complications. And the incidence of traumatic wrist arthritis and carpal instability is also high.
From August 2005 to October 2007, 22 cases of distal radius fractures were treated with open reduction and internal fixation and all achieved good results. The classification of the fractures is according to the AO classification method. Of 22 cases, 8 cases were classified as type A (A2, 2 cases; A3, 6 cases), while 6 cases were defined as type B (B2,4 cases; B3,2 cases) and 8 cases as type C (C1,4 cases; C2,1 case; C3,3 cases).
Insicion was firstly made at the radial of the flexor carpi radialis muscle on palmar (classical Henry incision), and the pronator quadratus muscle between the flexor carpi radialis muscle and radial artery was then revealed. The periosteum and the insertion of the pronator quadratus muscle at the lateral edge of the radial bone were cut, and then the fractures exposed. Attention should be paid not to damage too much periosteum and pronator quadratus muscle while revealing the fracture. Fracture could be reset after removing the soft tissue in it. The flatness of the artidular surface of the distal radius and the height of the radial styloid should be observed to restore the volar tilt of the distal radius' articular.
We used autoallergic bone graft to fill the fracture if the patients have bone defect and collapse, while AO "T" plate is applied to fix the fracture in the condition of the maintenance of good reduction. Attention was paid to suture of the pronator quadratus muscle to cover the plate and that will reduce the incidence of postoperative complications.
On the whole patients enrolled felt satisfied after the operation, and the mean functional recovery time was 4.84 months. The mean follow-up period was 13.55 months. The curative effect of the surgery was evaluated by the functional rating scale of Gartland and Werley, 11 cases were graded as excellent (accounting for 50%), 4 cases (18%) as good, 6 cases (27%) as fair and 1 case (5%) as poor.
We paid attention not to damage too much periosteum and pronator quadratus muscle and suture of the pronator quadratus muscle to cover the plate and that reduced the incidence of soft tissue adhesion, tendinitis and tendon rupture and other complications.
We believe that open reduction and internal fixation in the treatment of the distal radius fracture can make the fracture anatomical reduction, recover normal volar tilt and ulnar inclination. Also it can facilitate the early functional training of patients, so early restoration of wrist function can be achieved.
我院在2005年8月至2007年10月间,对22例骨折患者进行了切开复位内固定治疗,经随访8～24个月,患者功能恢复良好。按照Gartland与Werley临床功能评分标准,优11例,占50%;良4例,占18%;可6例,占27%;差1例,占5%。因此,桡骨远端骨折行切开复位内固定治疗,恢复骨骼正常解剖关系,能够取得良好疗效。
Distal radius fracture is very common in clinical works, which accounts for about 20% of all fractures. And dorsal intra-articular fracture is the most common type. The distal radius fracture is mainly occurred in the 6 to 10-year-old and 60 to 75-year-old phases as previous research statistics, but in recent years, the incidence of this type of fracture in young people increases gradually. Pouteau first described the fracture in 1783, and then scholars at home and abroad started to research the fracture. However, the long-term effect of this type of fracture is still uncertain because it has different injury forms and treatment methods.
The distal radius, the main connected structure of the forearm and wrist, locates superficially and has two physiological angles, which are the ulnar inclination varying from 13°to 30°with the mean 23°and the volar tilt with the angle of 10°to 12°on average. The activity scope of the radiocarpal joint is the biggest, amounting to 140°, and ulnar and radial drift is up to 60°. The distal radial ulnar joint can be rotated by 150°. As for the biomechanics, studies have shown that the radiocarpal joint bears 80% of the axial load.
Most of the distal radius fractures are due to falling with the hand over-stretched or the traffic accidents. Although Extra-articular fracture is the main injured type, comminuted fractures of distal radius are increasing in recent years due to the high-energy trauma. The distal radius is mainly composed by cancellous bone. During fracture the cancellous bone will collapse and then makes radius shortened and the ulnar inclination and volar tilt smaller, so it will produce a serious influence to the radiocarpal joint and distal radial ulnar joint in coordination and rotation.
When choosing method for treatment of the distal radius fracture the classification of fracture and the extent of damage should be considered. For simple, we can choose closed reduction and fixation method to treat stable extra-articular fracture and some intra-articular fracture. If the functional reduction can not be achieved or the location of the reset fracture can not be maintained, surgery is considered.
For the comminuted intra-articular fracture and invalid manipulative reduction cases, open reduction and internal fixation is a very effective means of treatment. It can maximize the restoration of the integrity of joints and provide anatomical basis of functional recovery. It is believed that surgery should be performed when the reduction can not be maintained after manipulative reduction and gypsum fixation. Specific indications include: (1) notable comminuted fractures; (2) a wide range dorsal smash up to 50% or more than diameter metaphysic; (3) displaced intra-articular comminuted fracture; (4) the articular surface shift >2 mm; (5) shortening>10mm; (6) major fracture block’s angle>20°; (7) osteoporosis; (8) age> 60 years old. The progress of open reduction and internal fixation currently is mainly reflected in two aspects which include internal fixation devices and improving of the choice of the operative approach.
At present the internal fixation materials include small "T" plate, screws, pinning, AO"π"-shaped plate, tube-shaped plate, as well as the locking compression plate (locking compression plate, LCP). Choosing suitable fixation material to treat different fractures will make the fractures’fixation and the restoration of joint function satisfying. It is reported that the LCP was used extensively and the results were always very good.
There are three operative approaches which are metacarpal approach, dorsal approach and union approach. We will illustrate the first two approaches in detail as follow. (1) Metacarpal approach: In this approach, the incision will be made at the radialis of the flexor carpi radialis muscle, and the pronator quadratus musle is revealed between the flexor carpi radialis muscle and radial artery. At last the operators will cut the periosteum and the insertion of the pronator quadratus musle at the lateral edge of the radial bone and then expose the fractures. (2)Dorsal approach: During dorsal approach, the incision is usually made between different extensor spacing according to different purposes. Making incision in the interval between the first and second extensor spacing is used to treat the fracture of the radial styloid, while incision in the dorsal of the Lister nodules crossing the 3rd dorsal interval should be made in revealing dorsal radial metaphysis and articular surface fracture. In recent years, it is observed that dorsal plate which is used to treat the distal radial fracture can make extensor tendon abrasion or rupture. Furthermore, dorsal incision often hurts superficial radial nerve and the branch of the radial artery. The branchs of dorsal ulnar nerve are also vulnerable when extending the incision to the dorsoulnar of the wrist. However, the metacarpal approach has small damage to cortical bone and the reset mark is very clear. Contrarily, palm side of the distal radius is very flat. So the setting of plate is easily achieved and the internal fixation is stable. In front of the plate there are pronator quadratus muscle and other soft tissues, so it can reduce the adhesion of soft tissue ,tendon inflammation ,wound infection and the exposure of the plate. Therefore, it tends to choose operative incision in the palm side. If there is bone defect autoallergic ilium graft can be chosen, which can induce bone growth and promote bone healing by providing support for intra-articular fracture. Penning thought that bone graft should be considered under the following circumstances: (1) shortening> 10 mm; (2) ulnaris bone shortening> 5 mm; (3) in patients with osteoporosis.
The merit of operation is that it can make the fracture anatomical reduction, and make normal volar tilt and ulnar inclination recovered. In this way patient may do functional training early, and restore the wrist function as far as possible.
However, the operation still has some inevitable complications. For example, injury of the nerve and tendon, tendon adhesion and ankylosis are the very common complications. And the incidence of traumatic wrist arthritis and carpal instability is also high.
From August 2005 to October 2007, 22 cases of distal radius fractures were treated with open reduction and internal fixation and all achieved good results. The classification of the fractures is according to the AO classification method. Of 22 cases, 8 cases were classified as type A (A2, 2 cases; A3, 6 cases), while 6 cases were defined as type B (B2,4 cases; B3,2 cases) and 8 cases as type C (C1,4 cases; C2,1 case; C3,3 cases).
Insicion was firstly made at the radial of the flexor carpi radialis muscle on palmar (classical Henry incision), and the pronator quadratus muscle between the flexor carpi radialis muscle and radial artery was then revealed. The periosteum and the insertion of the pronator quadratus muscle at the lateral edge of the radial bone were cut, and then the fractures exposed. Attention should be paid not to damage too much periosteum and pronator quadratus muscle while revealing the fracture. Fracture could be reset after removing the soft tissue in it. The flatness of the artidular surface of the distal radius and the height of the radial styloid should be observed to restore the volar tilt of the distal radius' articular.
We used autoallergic bone graft to fill the fracture if the patients have bone defect and collapse, while AO "T" plate is applied to fix the fracture in the condition of the maintenance of good reduction. Attention was paid to suture of the pronator quadratus muscle to cover the plate and that will reduce the incidence of postoperative complications.
On the whole patients enrolled felt satisfied after the operation, and the mean functional recovery time was 4.84 months. The mean follow-up period was 13.55 months. The curative effect of the surgery was evaluated by the functional rating scale of Gartland and Werley, 11 cases were graded as excellent (accounting for 50%), 4 cases (18%) as good, 6 cases (27%) as fair and 1 case (5%) as poor.
We paid attention not to damage too much periosteum and pronator quadratus muscle and suture of the pronator quadratus muscle to cover the plate and that reduced the incidence of soft tissue adhesion, tendinitis and tendon rupture and other complications.
We believe that open reduction and internal fixation in the treatment of the distal radius fracture can make the fracture anatomical reduction, recover normal volar tilt and ulnar inclination. Also it can facilitate the early functional training of patients, so early restoration of wrist function can be achieved.
引文
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2. Pechlaner S, et al. Distal radius fractures—aetiology, treatment and outcome. Handchir Mikrochir Plast Chir ,2007; 39:19–28.
3. Bengner U, Johnell O. Increasing incidence of forearm fractures.A comparison of epidemiologic patterns 25 years apart.Acta Orthop Scand, 1985; 56: 158-160.
4. 侯春林.桡骨远端骨折的治疗现状.中华手外科杂志,2006; 22: 1-2.
5. 顾玉东,王澍寰.手外科手术学,257.
6. 王满宜,杨庆铭等译.骨折治疗的 AO 原则,359-360.
7. 顾玉东,王澍寰.手外科学,421.
8. Short WH, Palmer AK, Werner FW,et al.A biomechanical study of distal radial fractures. Hand Surg(Am),1987; 12: 529-534.
9. 范清宇,唐农轩译.临床骨科学,4.
10. Rikli DA, Babst R.New principles in the surgical treatment of radius fractures-locking implants. Ther Umsch, 2003; 60:745-750.
11. Gausepohl T, Pennig D, Mailer K.Principles of external fixation and supplementary techniquesin distal radius factures.Injury, 2000; 31 (Suppl): 156-170.
12. Lee BP,Tan CT.Comminuted intrararticular gracture of the distal radius-results of early open reduction and internal fixation.Singapore Medical Hournal,1992; 33:612-615.
13. Edwards GS. Intra-articular fractures of the distal part of the radius treatedwith the small AO external fixator. J Bone Joint Surg A 1991; 73A:1241–50.
14. Webwe SC, Szabo RM. Severley comminuted distal radial fractures as an unresolved problem: complications associated with external fixation and pins and plaster techniques. J Hand Surg A 1986; 11A:157–65.
15. Bartosh RA, Saldana MJ: Intraarticular fractures of the distal radius:A cadaveric study to determine if tigamentotaxis restores radiopalmar tilt. J Hand Surg [AM].1990; 15:18-21.
16. Sommerkamp TG, Seeman M, Silliman J, Jones A, Patterson S,Walker J, Semmler M. Dynamic external fixation of unstable fractures of the distal part of the radius. J Bone Joint Surg A 1994; 76A:1149–61.
17. Dowgy PA.Patterson SD,King GI,et al.J Trauma,1990; 40:194-198.
18. Nienstedt F. The operative treatment of intra-articular Smith fractures. J Hand Surd, 1999; 24: 99-111.
19. Leibovie SJ,Geissler WB.Treatment of complex intra-articular distal radius fractures.Orthop Clin North Am,1994; 25:685-706.
20. Abbaszadegan H,Jonsson U,von Sivers K.Prediction of instability of Colles' fractures.Acta Orthop Scand,1989; 60:646-650.
21. Rozental TD, Beredjiklian PK,Bozentka DJ.Functional outcome and complications following two types of dorsal plating for unstable fractures of the distal part of the radius.J Bone Joint Surg(Am),2003; 85:1956-1960.
22. Hahnloser D,Platz A,Amgwerd M,et al.Internal fixation of distal radius fractures with dorsal dislocation:pi plate or two 1/4 rube plates?A prospective randomized study.J Trauma,1999; 47:760-766.
23. Musgrave DS, Idler RS. Volar fixation of dorsally displaced distal radiusfractures using the 2. 4-mm locking compression plates. J Hand Surg(Am),2005; 30: 743-750.
24. 王其友等.锁定加压接骨板在桡骨远端粉碎性骨折治疗中的应用.中华手外科杂志,2004; 20:162-163.
25. 陈晓东等.锁定钢板治疗桡骨远端粉碎性骨折.中华手外科杂志,2006; 22: 13-15.
26. Lipton HA, Wollstein R.Operative treatment of intra-articular distal radial fractures.Clin Orthop,1996; 327:110-124.
27. Penning D,Gausepohl T.External fixation of the wrist.Injury,1996,27:1-15.
28. Cooney WP 3rd, Linscheid RL, Dobyns JH. External pin fixation for unstable Colle's fractures.J Bone Joint Surg(Am),1979; 61:840-845
29. Doi K, Hattori Y, Otsuka K, Abe Y, Yamamoto H. Intra-articular fractures of the distal aspect of the radius: arthroscopically assisted reduction compared with open reduction and internal fixation. J Bone Joint Surg A 1999; 81A:1093–110.
30. Grechenig W,Fellinger M,Seibert FJ,et al.Distal radius fracture-The value of wrist arthroscopy in the acute setting.Eur J Trauma,2004; 6: 353-360.
31. Guofen C, Doi K,Hattori Y,et al. Arthroscopically assisted reduction and immobilization of intraarticular fracture of the distal end of the radius: several options of reduction and immobilization. Tech Hand Up Extrem Surg, 2005; 9: 84-90.
32. Simic PM,Weiland AJ.Fractures of the distal aspect of the radius:changes in treatment over the past two decades.Instr Course Lect, 2003; 52:185-195.
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34. Sun JS,Chang CH,Wu CC,et al.Extra articular deformity in distal radial fractures treated by external fixation.Can J Surg, 2001; 67: 289-294.
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37. Knirk JL,Jupiter JB.Intra articular fracture of the distal end of the radius in young adults.J Bone Joint Surg(Am),1986; 68:647-659.
38. Barati ME,Des Tardins JD,Anderson DD,et al.Displaced intra articular fracture of the distal radius the effect of fracture displacement on contact stresses in a cadaver model.J Hand Surg(Am),1996; 21:183-188.
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43. Beharrie AW,Beredjiklian PK,Bozentka DJ.Functional outcomes after open reduction and internal fixation for treatment of displaced distal radiusfractures in patients over 60 years of age.J Orthop Trauma,2004; 18:680-685.
44. Ark J, Jupiter JB. The rationale for precise management of distal radius fractures. Orthop Clin North Am 1993; 24: 205–10.
45. Baratz ME,Des Jardins J,Anderson DD,et al.Displaced intra-articular fractures of the distal radius:the effect of fracture displacement on contact stresses in a cadaver model.J Hand Surg(Am),1996; 21:183-188.
46. Palmer AK,Werner FW.Biomechanics of the distal radial radioulnar joint.Clin Orthop ,1984; 187:26-35.
47. Kihara H,Palmer AK,Werner FW,et al.The effect of dorsally angulated distal radius fractures on distal radioulnar joint congruency and forearm rotation.J Hand Surg(Am),1996; 21:40-47.
48. Young BT, Rayan GM. Outcome following nonoperative treatment of displaced distal radius fractures in low-demand patients older than 60 years. J Hand Surg (Am),2000; 25: 19-28.
2. Pechlaner S, et al. Distal radius fractures—aetiology, treatment and outcome. Handchir Mikrochir Plast Chir ,2007; 39:19–28.
3. Bengner U, Johnell O. Increasing incidence of forearm fractures.A comparison of epidemiologic patterns 25 years apart.Acta Orthop Scand, 1985; 56: 158-160.
4. 侯春林.桡骨远端骨折的治疗现状.中华手外科杂志,2006; 22: 1-2.
5. 顾玉东,王澍寰.手外科手术学,257.
6. 王满宜,杨庆铭等译.骨折治疗的 AO 原则,359-360.
7. 顾玉东,王澍寰.手外科学,421.
8. Short WH, Palmer AK, Werner FW,et al.A biomechanical study of distal radial fractures. Hand Surg(Am),1987; 12: 529-534.
9. 范清宇,唐农轩译.临床骨科学,4.
10. Rikli DA, Babst R.New principles in the surgical treatment of radius fractures-locking implants. Ther Umsch, 2003; 60:745-750.
11. Gausepohl T, Pennig D, Mailer K.Principles of external fixation and supplementary techniquesin distal radius factures.Injury, 2000; 31 (Suppl): 156-170.
12. Lee BP,Tan CT.Comminuted intrararticular gracture of the distal radius-results of early open reduction and internal fixation.Singapore Medical Hournal,1992; 33:612-615.
13. Edwards GS. Intra-articular fractures of the distal part of the radius treatedwith the small AO external fixator. J Bone Joint Surg A 1991; 73A:1241–50.
14. Webwe SC, Szabo RM. Severley comminuted distal radial fractures as an unresolved problem: complications associated with external fixation and pins and plaster techniques. J Hand Surg A 1986; 11A:157–65.
15. Bartosh RA, Saldana MJ: Intraarticular fractures of the distal radius:A cadaveric study to determine if tigamentotaxis restores radiopalmar tilt. J Hand Surg [AM].1990; 15:18-21.
16. Sommerkamp TG, Seeman M, Silliman J, Jones A, Patterson S,Walker J, Semmler M. Dynamic external fixation of unstable fractures of the distal part of the radius. J Bone Joint Surg A 1994; 76A:1149–61.
17. Dowgy PA.Patterson SD,King GI,et al.J Trauma,1990; 40:194-198.
18. Nienstedt F. The operative treatment of intra-articular Smith fractures. J Hand Surd, 1999; 24: 99-111.
19. Leibovie SJ,Geissler WB.Treatment of complex intra-articular distal radius fractures.Orthop Clin North Am,1994; 25:685-706.
20. Abbaszadegan H,Jonsson U,von Sivers K.Prediction of instability of Colles' fractures.Acta Orthop Scand,1989; 60:646-650.
21. Rozental TD, Beredjiklian PK,Bozentka DJ.Functional outcome and complications following two types of dorsal plating for unstable fractures of the distal part of the radius.J Bone Joint Surg(Am),2003; 85:1956-1960.
22. Hahnloser D,Platz A,Amgwerd M,et al.Internal fixation of distal radius fractures with dorsal dislocation:pi plate or two 1/4 rube plates?A prospective randomized study.J Trauma,1999; 47:760-766.
23. Musgrave DS, Idler RS. Volar fixation of dorsally displaced distal radiusfractures using the 2. 4-mm locking compression plates. J Hand Surg(Am),2005; 30: 743-750.
24. 王其友等.锁定加压接骨板在桡骨远端粉碎性骨折治疗中的应用.中华手外科杂志,2004; 20:162-163.
25. 陈晓东等.锁定钢板治疗桡骨远端粉碎性骨折.中华手外科杂志,2006; 22: 13-15.
26. Lipton HA, Wollstein R.Operative treatment of intra-articular distal radial fractures.Clin Orthop,1996; 327:110-124.
27. Penning D,Gausepohl T.External fixation of the wrist.Injury,1996,27:1-15.
28. Cooney WP 3rd, Linscheid RL, Dobyns JH. External pin fixation for unstable Colle's fractures.J Bone Joint Surg(Am),1979; 61:840-845
29. Doi K, Hattori Y, Otsuka K, Abe Y, Yamamoto H. Intra-articular fractures of the distal aspect of the radius: arthroscopically assisted reduction compared with open reduction and internal fixation. J Bone Joint Surg A 1999; 81A:1093–110.
30. Grechenig W,Fellinger M,Seibert FJ,et al.Distal radius fracture-The value of wrist arthroscopy in the acute setting.Eur J Trauma,2004; 6: 353-360.
31. Guofen C, Doi K,Hattori Y,et al. Arthroscopically assisted reduction and immobilization of intraarticular fracture of the distal end of the radius: several options of reduction and immobilization. Tech Hand Up Extrem Surg, 2005; 9: 84-90.
32. Simic PM,Weiland AJ.Fractures of the distal aspect of the radius:changes in treatment over the past two decades.Instr Course Lect, 2003; 52:185-195.
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