| Fernandez Ⅳ型桡骨远端骨折脱位的微创治疗 |
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投稿时间：2013-08-02
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| 作者 | Author | 单位 | Address | E-Mail |
| 费俊梁 |
FEI Jun-liang |
南京医科大学附属南京医院骨科, 江苏 南京 210006 |
Department of Orthopaedics, Nanjing Hospital Affiliated to Nanjing Medical University, Nanjing 210006, Jiangsu, China |
feijunliang@aliyun.com |
| 梁斌 |
LIANG Bin |
南京医科大学附属南京医院骨科, 江苏 南京 210006 |
Department of Orthopaedics, Nanjing Hospital Affiliated to Nanjing Medical University, Nanjing 210006, Jiangsu, China |
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| 蒋纯志 |
JIANG Chun-zhi |
南京医科大学附属南京医院骨科, 江苏 南京 210006 |
Department of Orthopaedics, Nanjing Hospital Affiliated to Nanjing Medical University, Nanjing 210006, Jiangsu, China |
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| 王黎明 |
WANG Li-ming |
南京医科大学附属南京医院骨科, 江苏 南京 210006 |
Department of Orthopaedics, Nanjing Hospital Affiliated to Nanjing Medical University, Nanjing 210006, Jiangsu, China |
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| 期刊信息：《中国骨伤》2014年，第27卷，第4期，第341-345页 |
| DOI：10.3969/j.issn.1003-0034.2014.04.018 |
| 基金项目: |
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中文摘要:
目的：探讨采用小切口微创复位腕关节动力外固定支架结合克氏针治疗Fernandez Ⅳ型桡骨远端骨折脱位的临床疗效。
方法：自2007年1月至2012年10月，选取桡骨远端骨折（Fernandez Ⅳ型，韧带附着点撕脱型骨折）合并桡腕关节脱位患者19例，男14例，女5例；年龄22～42岁，平均36.5岁。采用微创复位，安装动力外固定支架，克氏针维持固定桡腕关节面及纠正背伸不稳、掌屈不稳。测定腕关节的活动范围和影像学指标，对腕关节功能进行Gartland-Werley评分评定腕关节功能恢复情况。
结果：术后无钉道感染、固定松动和医源性神经血管损伤。行标准腕关节正侧位X线摄片，测量得桡月角（9.5±3.3）°，舟月角（51.3±11.2）°，桡骨远端长度（11.2±1. 8） mm.随访未出现再移位，无桡腕关节的半脱位或背伸不稳、掌屈不稳。术后3个月Gartland-Werley功能评分3.02±3.05.
结论：Fernandez Ⅳ型桡骨远端骨折脱位采用小切口微创复位腕关节动力外固定支架结合克氏针有限内固定的治疗方案疗效确切，可恢复正常桡月角、舟月角及桡骨远端长度。 |
| 【关键词】桡骨骨折 脱位 关节不稳性 外固定器 |
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| Minimally invasive treatment for distal radial fracture and dislocation of type Ⅳ based on Fernandez classification |
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ABSTRACT
Objective: To investigate the effects of external fixation combined with minimally invasive internal fixation for the treatment of distal radial fracture and dislocation of type Ⅳ based on Fernandez classification.
Methods: From January 2007 to October 2012,19 patients with the distal radius fracture and dislocation of type Ⅳ according to Fernandez classification were reviewed. There were 14 males and 5 females,ranging in age from 22 to 42 years old,with an average of 36.5 years old. All the patients were treated with minimally invasive reduction,and external fixation with finite internal fixation. The K-wire was used to fix radiolunate articular surface for correcting the instability of dorsal and volar intercalated segment. The radiolunate angle,scapholunate angle,and the length of the radial shorting were measured by the standard X-ray. Gartland and Werley evaluation system was used to evaluate recovery of function.
Results: No complications such as injury of blood vessels and radial nerves and pin track infections occurred. After operation,the radiolunate angle,scapholunate angle and the length of the radial shorting time were (9.5±3.3)°,(51.3±11.2)°and (11.2±1.8) mm by the standard X-ray. On the 3 rd month after operation,GW score was 3.02±3.05. There was no re-displacement and subluxation occurred during the follow-up period. Good functional recovery were improved wrist function significantly.
Conclusion: External fixation combined with minimally invasive internal fixation can treat distal radial fracture and dislocation of type Ⅳ based on Fernandez classification. Wrist joint stability depends on the structure of the bone and ligament around wrist joint. Emphasis on the diagnosis and treatment of carpal instability,and postoperative functional rehabilitation can improve wrist function. |
| KEY WORDS Distal fractures Dislocations Joint instability External fixators |
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| 引用本文，请按以下格式著录参考文献： |
| 中文格式: | 费俊梁,梁斌,蒋纯志,王黎明.Fernandez Ⅳ型桡骨远端骨折脱位的微创治疗[J].中国骨伤,2014,27(4):341~345 |
| 英文格式: | FEI Jun-liang,LIANG Bin,JIANG Chun-zhi,WANG Li-ming.Minimally invasive treatment for distal radial fracture and dislocation of type Ⅳ based on Fernandez classification[J].zhongguo gu shang / China J Orthop Trauma ,2014,27(4):341~345 |
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