腕关节镜下治疗桡骨远端关节内骨折

目的探讨腕关节镜监视下治疗桡骨远端关节内骨折的方法,以获得更好的治疗效果。方法39例桡骨远端关节内骨折患者,在腕关节镜监视下将骨折块撬拨复位,达到关节面基本平整,移位小于2mm。然后用克氏针、螺钉或有限切开支撑钢板固定,必要时结合外固定支架维持稳定固定。进一步检查腕关节内韧带,特别是舟月韧带、月三角韧带和三角纤维软骨复合体(triangularfibrocartilagecomplex,TFCC)的损伤。在腕关节镜下对相应的韧带损伤进行修整、清理和克氏针固定。结果39例桡骨远端关节内骨折,按AO分型属B型或C型。镜下显示32例骨折线位于关节面中央区,7例位于关节面边缘区,可发生劈裂和(或)塌陷移位;并有腕骨软骨面不同程度损伤,其中舟骨13例,月骨8例;术中发现骨折合并月三角韧带撕裂8例,合并舟月韧带撕裂15例,合并TFCC撕裂22例。经临床随访31例,平均32.4个月,腕关节活动度按TAM标准评定,优良率为84%。X线检查显示骨折愈合良好,无明显畸形或创伤性关节炎表现。患者自我满意率96.8%。结论腕关节镜下治疗桡骨远端关节内骨折既可以进行关节内软骨面的复位,减少创伤性骨关节炎的发生;又可以了解腕关节内韧带和TFCC等结构的损伤程度,便于早期处理,以防遗留慢性腕痛或腕关节不稳定。

Arthroscopically assisted treatment of intra-articular fracture of distal end of the radius

Objective To explore the therapeutic method of intra-articular fracture of d istal end of the radius under surveillance of wrist arthroscope.Methods Since December1996,39cases were treated arthroscopically with reduction by pry ing,fixation with Kirscher wire screw or buttress plate through limited exposu re,and if necessary,external fixator was used to make fixation more stable.T he displacement of the fracture was controlled within2mm.The scapho-lunate ligament,luno-triquetral ligament and triangular fi-brocartilage complex(TF CC)in the wrist joint were investigated and cleaned up or repaired if injured .In the present series,there were24males and15females,aging from13to6 8years old(the average of 43.4years).Results The fracture type of the s eries belong to type B(4cases)or type C(35cases)according to the classif ication of AO.Of 39cases,the fracture line of 32cases located at the cent ral region of articular sur face,the fracture line of the other7cases locate d at the border zone of articular surface.Other accompa-nied in juries in wri st were also found during operation,including of the injury of chondral surfa ce of carpal bone(13cases in scaphoid,8cases in lunate bone),the cleavag e and collapse displacement of the fracture,the in jury of ligament (8case s with lunotriguetal ligament ,15cases with scapholunate ligament and22cas es with TFCC).The mean follow-up of 31cases was32.4months.All the frac ture healed well without obvious de-formity and traumatic arthritis in X-ray examination.According to TAM standard,the excellent and good rate of the ran ge of motion of wrist joint was84%.96.8%of the patients were satisf ied.Conclusion The advantages of this therapeutic procedure is to obtain the r eduction of intra-articular chondral surface easily,to investigate and repair the injured ligament and TFCC under arthroscope simultaneously.In this way,i t is likely to re duce the chance of traumatic arthritis and prevent the pain or instability of the wrist.