手术治疗桡骨远端骨折78例疗效分析
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摘要
目的评估桡骨远端骨折的分型及手术疗效。方法对手术治疗的78例桡骨远端骨折按AO分型。A型系关节外干骺端骨折,但断端粉碎,闭合复位后难以维持掌倾角,分别采用由背侧和掌侧入路斜T型解剖钢板或锁定钢板内固定术。对骨折年龄大、拒绝切开复位患者,采用闭合复位交叉克氏针内固定;B型为部分关节内骨折,采用锁定钢板内固定。其中B1型为单纯桡骨茎突骨折,采用桡背侧入路,松质骨拉力螺钉内固定;C型是因压缩损伤引起的完全关节内骨折和断端嵌插,采用锁定钢板及克氏针联合固定;其余病例在C型臂X线机透视下功能复位,用外固定架维持桡骨长度。结果术后72例获得随访(13.7±7.2)个月,Lidstrom评定:其中A型38例,手腕功能恢复良好,优良率84.2%。B型20例腕关节功能优良率65%,无创伤性腕关节炎发生。C型14例,腕关节功能优良率42.8%,共有5例发生严重创伤性腕关节炎。结论桡骨远端骨折按AO分型,对不同程度的粉碎性骨折,采取不同的手术方法,能够取得满意的疗效。
Objective To study the prognosis and classification of the distal radius fracture. Methods Seventy-eight cases of the distal radius fracture were treated. According to AO classification, fractures were divided into three types. Type A were extraarticular metaphyseal bending fractures. Type A fractures were treated with closed reduction and anatomic reduction to restore radial inclination and palmar tilt, using oblique T-shaped anatomic plate or locking plate internal fixation from the dorsal side and palm side respectively, the fracture of old patients, who refused to aclept open reduction was treated by closed reduction and fixed by cross kirschner's needle; Type B were intraarticular. Using locking plate internal fixation. B1 was simple fracture of styloid process of radius, using radial lateral approach, internal fixation with cancellous bone lagscrew; Type C were treated with open reduction and external fixation. The combination of locking steel plate and kirschner's needle were used for fixation. In addition, the functional reduction was adopted under the C-shaped arm X-ray perspective, and the radius length was maintained with the external fixator. Results Postoperative follow-up was(13.7 ±7.2) months. All 72 cases were followed up. According to lidstrom evaluates: In type A(38 cases), hand and wrist joint function was restored nearly to normal, Excellent rate was 84.2%; In type B(20 cases), the good and excedent rate of wrist function was 65%, without any arthritis; In type C(14 cases) the good and excedect rate of wrist function was 42.8%. There were 5 cases of severe traumatic arthritis of the wrist. Conclusion AO's classification could assess the prognosis and guide treatment of fractures of the distal radius.
Objective To study the prognosis and classification of the distal radius fracture. Methods Seventy-eight cases of the distal radius fracture were treated. According to AO classification, fractures were divided into three types. Type A were extraarticular metaphyseal bending fractures. Type A fractures were treated with closed reduction and anatomic reduction to restore radial inclination and palmar tilt, using oblique T-shaped anatomic plate or locking plate internal fixation from the dorsal side and palm side respectively, the fracture of old patients, who refused to aclept open reduction was treated by closed reduction and fixed by cross kirschner's needle; Type B were intraarticular. Using locking plate internal fixation. B1 was simple fracture of styloid process of radius, using radial lateral approach, internal fixation with cancellous bone lagscrew; Type C were treated with open reduction and external fixation. The combination of locking steel plate and kirschner's needle were used for fixation. In addition, the functional reduction was adopted under the C-shaped arm X-ray perspective, and the radius length was maintained with the external fixator. Results Postoperative follow-up was(13.7 ±7.2) months. All 72 cases were followed up. According to lidstrom evaluates: In type A(38 cases), hand and wrist joint function was restored nearly to normal, Excellent rate was 84.2%; In type B(20 cases), the good and excedent rate of wrist function was 65%, without any arthritis; In type C(14 cases) the good and excedect rate of wrist function was 42.8%. There were 5 cases of severe traumatic arthritis of the wrist. Conclusion AO's classification could assess the prognosis and guide treatment of fractures of the distal radius.
引文
[1]荣国威,翟桂华主译.骨科内固定[M].第3版.北京:人民卫生出版社,2000.81-96.
[2]Lidstrom A.Fractures of the distal end of the raddius[J].Acta Orthop Scand,1959,﹙Suppl﹚:114-118.
[3]卢世璧主译.坎贝尔骨科手术学[M].第9版.济南:山东科学技术出版社,2003.2294-2298.
[4]Wahlstrom O.Treatment of Colles s fracture[J].Acta Orthoap Scand,1982,53:225-228.
[5]Kitay A,Swanstrom M,Schreiber JJ,et al.Volar plate position and flexor tendon rupture following distal radius fracture fixation[J].J Hand Surg Am,2013,38(6):1091-1096.
[6]Fok MW,Klausmeyer MA,Fernandez DL,et al.Volar plate fixa-tion of intra-articular distal radius fractures:a retrospective study[J].J Wrist Surg,2013,2(3):247.
[7]郑上团,吴斗.桡骨远端骨折的治疗进展[J].中华骨科杂志,2016,36(5):314-320.
[8]Vichard P,Gagneux E,Ridoux PE.La place de I,osteosyn these a laplaque console postereure dans le traitement des fractures de I,extremite inferieure du radi,par compression-extension[J].Ann Chir Main Memb Super,1994,13:87-100.
[9]黄卫国,马栋.掌侧锁定钛板与外固定架治疗C型桡骨远端骨折的中期疗效比较[J].中华骨科杂志,2015,35(7):734-740.
[10]Vlcek M,Jaganjac E,Pech J,et al.Is minimally invasive applica-tion by intramedullary osteosynthesis in comparison with volarplating real benefit in the treatment of distal radius fractures[J].Bosn J Basic Med Sci,2014,14(2):81-88.
[11]王坤正,王岩.关节外科教程[M].北京:人民卫生出版社,2014.605-607.
[2]Lidstrom A.Fractures of the distal end of the raddius[J].Acta Orthop Scand,1959,﹙Suppl﹚:114-118.
[3]卢世璧主译.坎贝尔骨科手术学[M].第9版.济南:山东科学技术出版社,2003.2294-2298.
[4]Wahlstrom O.Treatment of Colles s fracture[J].Acta Orthoap Scand,1982,53:225-228.
[5]Kitay A,Swanstrom M,Schreiber JJ,et al.Volar plate position and flexor tendon rupture following distal radius fracture fixation[J].J Hand Surg Am,2013,38(6):1091-1096.
[6]Fok MW,Klausmeyer MA,Fernandez DL,et al.Volar plate fixa-tion of intra-articular distal radius fractures:a retrospective study[J].J Wrist Surg,2013,2(3):247.
[7]郑上团,吴斗.桡骨远端骨折的治疗进展[J].中华骨科杂志,2016,36(5):314-320.
[8]Vichard P,Gagneux E,Ridoux PE.La place de I,osteosyn these a laplaque console postereure dans le traitement des fractures de I,extremite inferieure du radi,par compression-extension[J].Ann Chir Main Memb Super,1994,13:87-100.
[9]黄卫国,马栋.掌侧锁定钛板与外固定架治疗C型桡骨远端骨折的中期疗效比较[J].中华骨科杂志,2015,35(7):734-740.
[10]Vlcek M,Jaganjac E,Pech J,et al.Is minimally invasive applica-tion by intramedullary osteosynthesis in comparison with volarplating real benefit in the treatment of distal radius fractures[J].Bosn J Basic Med Sci,2014,14(2):81-88.
[11]王坤正,王岩.关节外科教程[M].北京:人民卫生出版社,2014.605-607.