| 手法间接复位掌侧锁定板固定治疗桡骨远端C3型骨折 |
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Received:December 25, 2013
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| 作者 | Author | 单位 | Unit | E-Mail |
| 张川 |
ZHANG Chuan |
河南省洛阳正骨医院上肢损伤科, 河南 洛阳 471002 |
Department of Upper Limb Injury, Orthopaedics Hospital of Henan, Luoyang 471002, Henan, China |
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| 张作君 |
ZHANG Zuo-jun |
河南省洛阳正骨医院上肢损伤科, 河南 洛阳 471002 |
Department of Upper Limb Injury, Orthopaedics Hospital of Henan, Luoyang 471002, Henan, China |
zc360006@163.com |
| 王蕾 |
WANG Lei |
上海交通大学医学院附属瑞金医院, 上海 200025 |
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| 牛素玲 |
NIU SU-ling |
河南省洛阳正骨医院上肢损伤科, 河南 洛阳 471002 |
Department of Upper Limb Injury, Orthopaedics Hospital of Henan, Luoyang 471002, Henan, China |
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| 闻亚非 |
WEN Ya-fei |
河南省洛阳正骨医院上肢损伤科, 河南 洛阳 471002 |
Department of Upper Limb Injury, Orthopaedics Hospital of Henan, Luoyang 471002, Henan, China |
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| 郭艳幸 |
GUO Yan-xing |
河南省洛阳正骨医院上肢损伤科, 河南 洛阳 471002 |
Department of Upper Limb Injury, Orthopaedics Hospital of Henan, Luoyang 471002, Henan, China |
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| 期刊信息：《中国骨伤》2014年27卷，第11期，第965-969页 |
| DOI：10.3969/j.issn.1003-0034.2014.11.020 |
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目的: 探讨手法间接复位后AO 2.4 mm桡骨远端锁定板联合经皮穿针固定治疗C3型(AO/OTA分型)桡骨远端骨折的临床疗效及操作技巧.
方法: 自2009年5月至2012年3月采用手法间接复位AO 2.4 mm桡骨远端掌侧锁定板联合经皮穿针固定治疗桡骨远端骨折AO/OTA分型C3型患者19例21腕(双侧2例).年龄31～66岁,平均(45.3±17.4)岁;并发尺骨茎突骨折14腕,下尺桡关节不稳6腕;均为闭合性骨折;发病时间4.5～9 d,平均(6.7±3.5) d.采用Henry切口显露骨折部位,保留关节囊、韧带连续性,手法间接复位,C形臂X线透视关节面复位情况,仍存在塌陷者予以撬拨复位后桡骨远端掌侧锁定板固定.下尺桡关节发现不稳定和并发尺骨茎突骨折者均予前臂旋后位石膏托固定6周.
结果: 19例(21腕)获得随访,时间7～17个月,平均10.5个月.X线示患者桡骨远端骨折均达到骨性愈合,尺骨茎突骨折未愈合3例,下尺桡关节不稳0例,1例出现背侧伸肌腱激惹,内固定取出后激惹消除.术后随访观测患者掌倾角、尺偏角、桡骨茎突高度、关节面和下尺桡关节情况,按照Batra和Gupta评分标准行影像学评定：70分以下3腕,70～79分5腕,80分以上13腕.同时对患者进行主观和客观疗效评定,观测残留畸形和腕关节活动度、并发症情况等,根据Sarmiento改良的Gartland-Werley评分系统评定术后疗效：优17腕,良3腕,可1腕.
结论: AO/OTA分型C3型桡骨远端骨折手法间接复位可获得良好复位效果,应用锁定板联合穿针可为其提供内固定架支撑式固定以满足早期功能锻炼要求,患腕功能预后良好. |
| [关键词]:桡骨骨折 手法复位 骨折固定术,内 内固定器 |
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| Treatment of type C3 distal radius fractures with AO 2.4 mm locking plate system after manipulative reduction |
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Abstract:
Objective: To summarize our experiences in the treatment of type C3(AO/OTA) distal radius fractures fixed with AO 2.4 mm locking plates combined with percutaneous pinning after manipulative reduction.
Methods: From May 2009 to March 2012,19 patients(2 cases of both sides) with type C3(AO/OTA) distal radius fractures were treated with volar locking plates combined with percutaneous pinning for distal radius after manipulative reduction. Among the patients,the average age was (45.3±17.4) years old(ranged,31 to 66 years old). The fracture were complicated with ulnar styloid fracture in 14 wrists and 6 wrists had distal radioulnar joint instability. All the patients had closed fracture and the mean duration was(6.7±3.5) days(4.5 to 9 days). The Henry approach was applied to expose the fracture site. Joint capsule and ligaments were retained for indirect reduction. After indirect reduction,the poking reduction technique was used to correct the residual compression,and congruence of distal ulnar radial joint was verified under fluorscopic guidance. Styloid process was first pinned percutaneously and then AO 2.4 mm volar locking plate was used to support rigid fixation. The fractures complicated with distal radioulnar joint instability and ulnar styloid fracture were treated with forearm plaster support in supination for 6 weeks.
Results: Nineteen patients(21 wrists) were followed up for an average duration of 10.5 months (ranged,7 to 17 months). Radiographic bone union of distal radius was achieved in all cases,nonunion of the ulnar styloid occurred in 3 cases,and no distal radioulnar joint instability occurred. Tendon irritation was found in 2 cases and disappeared after the internal fixation was removed. The volar tilt,radial angle,radial length,incongruence of articular surface and distal radioulnar joint were observed at the follow-up. According to Batra and Gupta scoring system,13 wrists were assessed to have a score of more than 80,5 wrists 70 to 90,3 wrists less than 70. Meanwhile,the subjective and objective evaluation was executed,range of motion of wrist,residual deformity and complications were observed. According to Sarmiento's modification of the system of Gartland and Werley,17 wrists got an excellent result,3 good and 1 fair.
Conclusion: Type C3(AO/OTA) distal radius fractures could be managed with manipulative reduction. Locking plate internal fixation combined with percutaneous pinning can offer enough support for early mobilization and rehabilitation,resulting in a better clinical outcome and satisfactory prognosis. |
| KEYWORDS:Radius fractures Manipulative reduction Fracture fixation,internal Internal 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: | 张川,张作君,王蕾,牛素玲,闻亚非,郭艳幸.手法间接复位掌侧锁定板固定治疗桡骨远端C3型骨折[J].中国骨伤,2014,27(11):965~969 |
| 英文格式: | ZHANG Chuan,ZHANG Zuo-jun,WANG Lei,NIU SU-ling,WEN Ya-fei,GUO Yan-xing.Treatment of type C3 distal radius fractures with AO 2.4 mm locking plate system after manipulative reduction[J].zhongguo gu shang / China J Orthop Trauma ,2014,27(11):965~969 |
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