掌侧LCP结合Kapandji技术治疗背侧不稳定桡骨远端关节内骨折初步报道

目的 探讨掌侧锁定加压钢板(locking compression plate,LCP)结合Kapandji技术治疗背侧不稳定桡骨远端关节内骨折的方法 及疗效.方法 背侧不稳定桡骨远端关节内骨折患者43例,男17例,女26例;年龄42～65岁,平均57岁.按AO/ASIF分型,C1型26例,C2型16例,C3型1例.采用掌侧LCP结合Kapandji技术进行治疗.在Stewart等改良的Sarmiento评分基础上再次进行改良,从掌倾角、尺偏角、桡骨短缩和关节面台阶方面对桡骨远端影像学进行评估;采用Gartland-Werley功能评分对腕关节功能进行评估.结果 所有患者均获得随访,随访时间16～47个月,平均27个月.掌倾角由术前-19.3°±11.2°改善至术后8.1°±3.2°,尺偏角由术前-13.6°±4.1°改善至术后18.0°±8.2°,桡骨短缩由术前(6.2±2.8)mm改善至术后(0.2±0.2)mm,关节面塌陷由术前(5.5±4.3)mm改善至术后(0.1±0.2)mm.在Stewart等改良的Sarmiento评分基础匕再次进行改良的评分,优34例,良9例;Gartland-Werley功能评分,优18例,良22例,可3例.结论 掌侧LCP结合Kapandji技术是治疗背侧不稳定桡骨远端关节内骨折的一种有效方法 ,可有效防止复位丢失、肌腱激惹等并发症,减少结构性植骨及行早期关节活动.     

复杂桡骨远端骨折的手术治疗

目的 探讨手术治疗复杂桡骨远端骨折的疗效.方法 对65例复杂桡骨远端骨折根据骨折类型及特点,采用切开复位关节面,植骨支撑桡骨远端关节面,恢复掌倾角、尺偏角,应用钢板、克氏针、外固定架等方法 联合固定.随访观察骨折愈合时间、腕关节活动范围,术后掌倾角、尺偏角的平均角度.结果 本组随访时间8～24个月,平均12.5个月.所...     

外固定架联合钢板及克氏针内固定治疗老年桡骨远端不稳定粉碎性骨折

目的探讨应用外固定架联合钢板及克氏针有限内固定治疗老年桡骨远端不稳定骨折的术后疗效。方法采取外固定架辅助钢板及(或)克氏针有限内固定治疗老年桡骨远端不稳定粉碎性骨折68例。结果 68例均获得随访1.5年,骨折愈合时间平均18周。按Dienst功能评估标准:优53例,良12例,一般3例,优良率为95.6%。结论外固定架联合钢板及克氏针有限内固定治疗老年不稳定桡骨远端骨折在术中能够维持桡骨远端关节面平整,恢复掌倾角、尺偏角及桡骨长度,同时能够提供满足早期腕关节功能锻炼的稳定性,是一种较为理想的治疗方法。     

外固定架治疗不稳定性桡骨远端关节内骨折的疗效分析

目的评估外固定架治疗不稳定性桡骨远端关节内骨折的临床效果。方法共纳入37例桡骨远端骨折患者,男24例,女13例;年龄23~62岁,平均(43.6±12.9)岁,均行外固定架治疗。术后2周、1个月、3个月、6个月和12个月行常规随访,包括测量腕关节活动度、握力及影像学结果(掌倾角、尺偏角、桡骨高度、尺骨变异、关节面塌陷)。上肢功能评定标准(disabilities of the arm,shoulder and hand,DASH)和Gartland-Werley腕关节评分标准用以对功能恢复进行综合评估。记录术后及随访期间并发症发生率。结果本组患者均获随访,随访时间12~32个月,平均(15.6±1.8)个月。末次随访时,腕关节活动度分别为:屈曲(63.2±7.3)°,背伸(59.3±9.3)°,旋前(68.6±8.8)°,旋后(64.2±7.4)°;桡侧倾斜(19.3±5.7)°,尺侧倾斜(28.6±6.2)°;握力(24.2±2.5)kg。掌倾角(5.3±3.3)°,尺偏角(20.7±3.9)°,桡骨高度(10.3±1.9)mm,尺骨变异(1.5±1.3)mm,关节面塌陷(1.1±1.3)mm。总体功能评分:DASH评分平均(11.5±5.3)分,Gartland-Werley评分平均(3.3±2.9)分。37例患者中8例出现并发症,钉道感染3例,慢性区域性疼痛综合征(complex regional pain syndrome,CRPS)2例,桡神经感觉支受损1例,固定失败、需要重新调整再固定1例,术后僵硬1例。结论采用外固定架治疗不稳定性桡骨远端关节内骨折有利于恢复关节面平整,纠正短缩畸形,是一种有效的治疗方法,但术后并发症仍然较多,值得临床医生关注。     

微型钢板内固定治疗桡骨远端关节内和近关节骨折

目的探讨微型钢板内固定治疗不稳定桡骨远端关节内和近关节骨折的方法及效果。方法回顾性分析了自2008-01—2012-01采用2.0 mm微型钢板内固定治疗的72例(76侧)关节内及骨折线接近关节面的桡骨远端不稳定骨折,采用单一微型钢板内固定22侧,双微型钢板内固定26侧,微型钢板与T形钢板内固定19侧,微型钢板与锁定钢板内固定9侧。结果 72例术后获得平均18.5(12~30)个月随访。末次随访时掌倾角由术前平均-7.3°改善至术后7.4°,尺偏角由术前平均15.1°改善至术后22.2°,桡骨高度由术前平均7.9 mm改善至术后12.4 mm。影像学评分采用Stewart改良的Sarmiento标准评估:优59侧,良12侧,可5侧,优良率93.4%。腕关节功能按Gartland-Werley评分标准评估:优53侧,良14侧,可9侧,优良率88.2%。结论微型钢板内固定是治疗桡骨远端关节内和近关节骨折的有效方法,可灵活固定复杂骨折,软组织干扰少,能满足早期活动的需要。     

陈旧性桡骨远端骨折治疗20例

目的通过对20例陈旧性桡骨远端的治疗及术后功能评价总结陈旧性桡骨远端骨折的治疗方法。方法2017年1月-2018年10月,采用单侧或双侧切开复位内固定或内外固定加外固定治疗陈旧性桡骨远端骨折20例。均为闭合性骨折,按AO分型:A2型1例,A3型2例,B1型2例,C1型12例,C3型3例。所有患者均为手法复位不满意者。病程33~150 d,平均55 d。术前掌倾角(-18.0±4.1)°,尺偏角(14.8±7.0)°,桡骨短缩(14.2±3.6)mm,腕关节屈曲活动度(30.0±12.5)°,腕关节背伸活动度(35.0±5.5)°。腕关节旋前(65.0±10.0)°,旋后(65.0±15.0)°。结果术后患者切口均一期愈合,无术后早期并发症发生。全部患者均获随访,随访时间8~24个月,平均12个月。影像学检查示所有患者骨折均顺利愈合,愈合时间为8~14周,平均10周;末次随访时桡骨远端掌倾角为(12.1±4.1)°,尺偏角为(22.5±5.5)°,桡骨短缩(2.2±1.2)mm,腕关节屈曲活动度为(65.0±12.5)°,腕关节背伸活动度为(50.0±10.5)°。腕关节旋前(85.0±5.0)°,旋后(65.0±15.0)°,较术前均显著改善。末次随访时采用DASH基线评分,平均为14分。结论陈旧性桡骨远端骨折一旦有手术指征且患者要求改善目前不良症状的均应采取内固定辅以其他治疗方式,即内固定+外固定或两种不同的内固定方式,且绝大多数需植骨。     

以尺骨作为内固定治疗桡骨远端骨折

[目的]固定针插入桡骨远端的骨折近端和远端并固定于尺骨,即利用尺骨作为内固定支柱为桡骨远端骨折提供一种新方法。[方法]2012年10月~2014年8月,对21例桡骨远端不稳定骨折(远端骨折块足够大)采用新方法进行治疗。根据AO分类系统,12例为A3型骨折,9例为C2型骨折。临床疗效评价指标包括骨折愈合、并发症、疼痛、握力、腕关节活动范围。影像学评价包括掌倾角、尺偏角、桡骨远端高度。[结果]平均随访18个月(6~24个月)。所有骨折均愈合,平均愈合时间6.8周(5~8周)。3例小的并发症:1例针道感染,2例克氏针松动。术后即刻与术后1年,掌倾角分别为(7.5±2.8)°、(6.4±3.4)°,尺偏角分别为(22.1±2.2)°、(21.3±2.5)°,尺骨变异分别为(0.6±1.5)mm、(1.0±0.8)mm。术后1年,患侧与健侧腕关节活动范围的比值:掌屈(92.2±5.4)%,背伸(91.3±4.2)%,旋后(93.3±5.2)%,旋前(93.6±4.8)%;患侧与健侧握力的比值(95.4±6.1)%。VAS评分平均(0.5±0.7)分,19例患者无疼痛。[结论]利用尺骨作为内固定支柱治疗桡骨远端不稳定骨折(远端骨折块足够大)是一种简单、微创的非桥接固定技术,能维持解剖、功能好。     

桡骨远端粉碎骨折的外固定架关节可以早期松开吗

[目的]观察早期松开桡骨远端粉碎骨折的外固定架关节对桡骨远端放射学指标的影响,探讨松开外固定架关节时间及对桡骨远端粉碎骨折预后的影响。[方法]将2008年1月~2010年3月,桡骨远端粉碎骨折患者共32例,采用外固定架及外固定架联合克氏针有限内固定,术后2周松开关节,通过透视及X线片,在松开后次日,1、2周监测桡骨远端掌倾角、尺偏角、桡骨高度等放射学指标,测量并记录松前及术后12周的数据。[结果]平均随访7.5个月,将桡骨远端掌倾角、尺偏角、桡骨高度等放射学指标数据作配对t检验,松前及术后12周的数据没有统计学差异。[结论]桡骨远端粉碎骨折采用带关节外固定架固定或联合有限内固定,在严密监视下早期松开关节功能锻炼对各角度没有明显影响,鼓励早期功能锻练。     

掌侧入路锁定加压钢板内固定术治疗老年桡骨远端关节内骨折的临床效果

目的分析掌侧入路锁定加压钢板内固定术治疗老年桡骨远端关节内骨折的临床效果。方法选取2018-12-2019-02间在濮阳市中医医院接受掌侧入路锁定加压钢板内固定术治疗的30例老年桡骨远端关节内骨折患者,对其临床资料进行回顾性分析。结果 30例患者均获6~12个月随访。骨折愈合时间为(6.52±1.20)周。其间未发生内固定松动、切口感染、神经和血管损伤、骨折延迟愈合或畸形愈合等并发症。术后3个月复查X片,掌倾角为(12.27±2.97)°,尺偏角为(22.18±2.69)°,桡骨茎突高度为(11.70±2.53)mm。末次随访,根据Sarmiento腕关节功能评分标准:本组优良率为90.00%。结论对老年桡骨远端关节内骨折患者,采用掌侧入路锁定加压钢板内固定术治疗,骨折愈合良好,并发症少,腕关节功能恢复效果肯定。     

微创撬拨复位克氏针支撑固定治疗跟骨骨折

目的 探讨微创撬拨复位克氏针支撑固定治疗跟骨骨折的临床疗效.方法 对38例(42足)跟骨骨折采用微创撬拨复位克氏针支撑固定.结果 38例均获随访14～20个月,平均18个月.跟骨结节Bohler角与Gissane角由术前平均(10.5±6.7)°、(133.5±7.5)°矫正至术后1周平均(31.2±6.4)°、(125.3±5.4)°,术前与术后1周比较差异有统计学意义(P＜0.05);末次随访时为(29.5±5.3)°、(127.5±6.1)°,与术前比较差异有统计学意义(P＜0.05),与术后1周比较差异无统计学意义(P＞0.05).结论 微创撬拨复位克氏针支撑固定治疗跟骨SandersⅡ、Ⅲ型骨折创伤小、操作简单、疗效良好.     

掌侧锁定接骨板与外固定架固定治疗不稳定桡骨远端关节内骨折的疗效比较

目的比较掌侧锁定接骨板与外固定架固定治疗不稳定桡骨远端关节内骨折的临床疗效。方法回顾性分析自2015-01—2018-03诊治的78例不稳定桡骨远端关节内骨折,47例采用掌侧锁定接骨板固定手术治疗(锁定板组),31例采用外固定架手术治疗(外固定组)。比较2组手术时间、并发症情况,以及末次随访时关节塌陷情况、DASH评分、Gartland-Werley评分、握力、屈曲度、背伸度、旋前度、旋后度、桡侧倾斜度、尺侧倾斜度。结果 78例均顺利完成手术,随访时间12~32个月,平均16.2个月。锁定板组手术时间较外固定组长,差异有统计学意义(P<0.05)。2组并发症情况比较差异无统计学意义(P>0.05)。末次随访时2组DASH评分、Gartland-Werley评分、握力、腕关节背伸度、旋后度、桡侧倾斜度以及尺侧倾斜度比较差异无统计学意义(P>0.05);锁定板组在屈曲度、旋前度表现较外固定组更好,关节塌陷数较外固定组少,差异有统计学意义(P<0.05)。结论掌侧锁定接骨板手术治疗不稳定性桡骨远端关节内骨折能更好地恢复腕关节的屈曲和旋前功能,维持关节面平整性,但并不能减少并发症以及获得更好的功能评分;医师应综合考虑骨折分型、关节面塌陷以及患者的需求,选择合适的手术方法。     

桡骨远端Barton骨折的微创治疗

目的探讨桡骨远端Barton骨折微创治疗的可行性。方法采用自行设计的新型外固定器,结合经皮撬拨、有限切开复位和经皮克氏针固定等微创技术治疗桡骨远端Barton骨折18例。结果术后3、12个月腕关节的活动范围较对侧正常腕关节相比无差异,桡骨高度和尺偏角较对侧正常腕关节相比无差异,掌倾角分别恢复53·7%、52·8%,小于对侧正常腕关节。Sarmiento功能评分:优11例,良5例,一般2例。结论新型外固定器能有效维持桡骨远端骨折的复位,使桡骨远端骨折的微创治疗成为可能。     

Dorsal plating for comminuted intra-articular fractures of the distal end of the radius.

Forty-one dorsally displaced intra-articular fractures of the distal radius were treated by open reduction and internal fixation with the dorsal Symmetry plates. The average age at the time of the injury was 49 years. An average follow-up period was 15 months. The final radial length averaged 11 mm, radial inclination 23 degrees, volar tilt 7 degrees, ulnar variance 1.5 mm, and articular incongruity 0.3 mm. According to the Gartland and Werly scales, 36 fractures were excellent and five were good. However, ulnar variance increased more than 3 mm during follow-up in eight patients, and volar tilt increased more than 5 degrees during follow-up in ten patients. Use of dorsal Symmetry plate is effective for unstable comminuted intra-articular distal radius fractures, but severely comminuted fractures may possibly undergo re-displacement post-operatively.     

外固定支架联合Kapandji技术微创治疗老年桡骨远端不稳定骨折

目的探讨外固定支架联合Kapandji技术治疗老年桡骨远端不稳定骨折的疗效。方法2012年5月~2016年2月对21例老年桡骨远端不稳定骨折(按AO分型:A3型6例,B2型3例,C2型9例,C3型3例)采用外固定支架联合克氏针经皮插入以阻挡骨块再移位的Kapandji技术。末次随访根据改良的Sarmiento评分进行影像学评估,根据Gartland-Werley功能评分标准进行腕关节功能评估。结果手术时间25~45 min,平均35.3 min。术后住院时间3~14 d,平均6.5 d。21例随访8~24个月,平均15.3月,骨折均获愈合。影像学评分:优17例,良4例;腕关节功能评分:优13例,良5例,可3例,优良率为85.7%(18/21)。结论外固定支架联合Kapandji技术是老年桡骨远端不稳定骨折有效的微创手术方法,易于操作,避免伸肌腱的刺激,可有效增强固定的稳定性,功能恢复良好。     

HoffmannⅡ Compact外固定架结合有限内固定治疗桡骨远端粉碎性骨折

目的探讨HoffmannⅡCompact外固定架结合经皮克氏针有限内固定治疗桡骨远端粉碎性骨折的临床疗效。方法采用HoffmannⅡCompact外固定架加经皮克氏针有限内固定治疗桡骨远端粉碎性骨折32例。结果32例均获随访,时间5-18（8±1.3）个月,骨折均骨性愈合,愈合时间35个月。术前尺偏角为-13°-14°（11.0°±2.1°）,掌倾角为-28°-0°（-9.5°±1.1°）;去除支架后测量：尺偏角为18°-34°（22.5°±2.5°）,掌倾角为0°-21°（12.5°±2.1°）,桡骨轴向缩短基本恢复正常,其中1例C3型缩短2 mm。关节功能按Dienst标准进行评定：优11例,良19例,可2例。结论Hoffmann Ⅱ Compact外固定架结合有限内固定治疗桡骨远端粉碎性骨折操作简单、固定可靠、疗效满意、并发症少。     

关节镜辅助治疗桡骨远端关节内骨折

目的 报告关节镜在桡骨远端关节内骨折复位固定中的辅助作用.方法 回顾2004-2007年间我院收治的12例桡骨远端骨折,在开放复位内固定术中应用关节镜进行腕关节内观察,检测关节面的对位情况,术后以放射学检查评估关节面的对位,并测量桡骨高度、掌倾角及桡偏角,随访临床腕关节功能恢复情况.结果 随访时间平均为24个月,12例桡骨远端关节内骨折术后均未出现关节面阶梯改变.X线片检查:桡骨高度平均为12 mm(7～15 mm),掌倾角平均为5°(1°～9°),桡偏角平均为20°(14°～28°).腕关节活动度:屈曲平均为33°(18°～42°),背伸平均为38°(21°～42°).6例活动时有轻微疼痛.根据Gartland和Werley的评估标准评定:优5例,良7例.结论 应用腕关节镜辅助治疗桡骨远端关节面骨折复位可避免关节面出现阶梯改变,最大程度地恢复关节的功能.     

Retrospective comparison of external fixation versus volar locking plate in the treatment of unstable intra-articular distal radius fractures

The aim of this study is to compare the radiological and functional outcomes of open reduction and volar locking plates versus external fixation (EF) in the treatment of unstable intra-articular distal radius fractures. In this retrospective comparative study, 69 of 80 patients who underwent an operation for AO/ASIF C1, C2 and C3 distal radius fractures were assessed. Functional evaluation was performed using the Gartland–Werley scoring system and the PRWE scale, and wrist range of motion and grip strength was also measured. For the radiological assessment, radial inclination, volar tilt, radial length, ulnar variance, and articular step-off were compared. The range of movement was better for all parameters in the volar plate group, but only wrist flexion and pronation range differed significantly between the groups (p = 0.037 and p = 0.014, respectively). With the exception of better subjective functional results in the volar plate group, the differences were not significant. With respect to radiological evaluation, all parameters were better in the volar plate group, but only radial inclination and articular step-off were significantly better (p = 0.018 and p = 0.029, respectively). In the volar plate group, two patients had carpal tunnel syndrome and one patient had regional pain syndrome. In the external fixator group, six patients had superficial pin tract infection, two patients had sensory branch injury, and four patients had regional pain syndrome. Volar locking plate fixation appeared as a dependable method for the treatment of intra-articular distal radius, with lower complication rates. On the other hand, EF remains a suitable surgical alternative for these fractures, with easy application and acceptable results.     

Treatment of Distal Radius Fractures with Percutaneous Pinning and Pin-in-plaster

This article describes a modified technique that combines percutaneous pinning and casting. A prospective study was conducted on 54 patients with distal radius fracture who were treated with percutaneous Kirschner wire (K-wire) fixation and pin-in-plaster technique. The surgical indications of this technique included displaced extra-articular fracture, intra-articular fracture without significant comminution, and articular step-off less than 2 mm. The average radial height was 10.96 mm, and the volar tilt was 3.97 degrees on immediate postoperative radiographs. Upon removal of pin-in-plaster and percutaneous K-wires, the average radial height was 9.92 mm, and the volar tilt was 3.93 degrees . Bony union was achieved in all patients; the satisfaction rate was 90.7%. Pin-in-plaster technique is effective for maintaining reduction during bone healing. The procedure provides the ability to achieve anatomic reduction and then maintains this reduction through an adequate method of immobilization.     

Combined Approach for Intra-articular Distal Radius Fracture: A Case Series and Literature Review

BackgroundThe purpose of this study was to classify the possible indications for a combined approach to distal radius fractures (DRFs) by investigating surgical outcomes of patients treated according to our treatment algorithm.MethodsA combined approach was performed in 32 patients. Patients who were thought to need a combined approach were classified into three types according to the combined injuries associated with loss of volar cortical buttresses in DRFs. The classifications included the following: type 1, free intra-articular fragments; type 2, distally migrated dorsal fragments located beyond the wrist joint; and type 3, centrally impacted articular fragments and displaced dorsal fragments, not reduced by indirect methods.ResultsSeven patients had type 1 fractures treated with volar plates and excision of the intra-articular fragments. Fourteen patients had type 2 fractures: 12 were treated with volar plates and excision of dorsal fragments, and 2 with relatively large unstable dorsal fragments were treated with combined volar and dorsal plates. The remaining 11 patients had type 3 fractures treated with combined volar and dorsal plates. At the latest follow-up, the radiographs revealed an average of 16.9° of radial inclination, an average of 4.2° of volar tilt, and an average of 7.5 mm of radial height. According to the Garland and Werley scores, the functional results were excellent for 3 patients, good for 25, and fair for 4.ConclusionsThe classification system indicated when an additional dorsal approach was needed in unstable DRFs, and it may establish useful guidelines for appropriate surgical decision-making.