保守治疗掌侧Barton骨折的临床探讨

目的：探讨保守治疗掌侧Barton骨折的指征和预后。方法：保守治疗23例掌侧Barton骨折患者,其中男8例,女15例;年龄16～84岁,平均52.2岁;骨折不伴桡腕关节掌侧半脱位7例,伴桡腕关节掌侧半脱位16例（Mehara Ⅰ型15例,Mehara Ⅲ型1例）。并对32具新鲜尸体标本进行实验,推断在掌侧Barton骨折的损伤机制中,桡腕关节背侧韧带损伤是产生桡腕关节向掌侧半脱位的重要原因。应用Pattee和Thompson的评价标准对治疗效果进行评价。结果：进行7～70个月随访,11例疗效满意（优1例、良10例）,12例不满意（中5例、差7例）。7例骨折不伴桡腕关节掌侧半脱位病例中,5例治疗结果满意;16例伴桡腕关节掌侧半脱位病例中,6例治疗结果满意。结论∶①复位结果影响掌侧Barton骨折的预后,复位后桡腕关节面移位应小于2mm。②不伴桡腕关节向掌侧半脱位,建议保守治疗。③伴有桡腕关节向掌侧半脱位,保守治疗预后欠佳,可试行手法整复、石膏外固定,如不能达到桡腕关节面移位小于2mm的标准,就应采取手术方法治疗。

Clinical investigation of conservative treatment for volar Barton fracture

Objective：To discuss the indication and outcome of volar Barton fracture treated by nonoperative method. Methods：Twenty-three cases of volar Barton fracture treated by closed method included 8 male and 15 female with an average age of 52.2 years, ranging 16 to 84 years. Among them, 16 cases showed subluxation of the carpus （ 15 cases were Mehara type Ⅰ, 1 case was Mehara type Ⅲ ）by radiographs except the other 7 cases. By the experimentation in 32 cadavers,the injury of dorsal radiocarpal ligament was supposed to be a very important cause of the subluxation of the radiocarpal joint. The criteria of Pattee and Thompson was used to evaluate the outcome of the treatment. Results ：Twenty-three patients were followed up for 7 to 70 months, 11 cases gained satisfactory outcome （1 case as excellent, 10 cases as good）, 12 cases gained unsatisfactory out- come （5 cases as fair, 7 cases as poor）. Five of 7 cases without the subluxation of the carpus by the radiographs gained satisfactory outcome. Six of 16 cases with the subluxation of the carpus gained satisfactory outcome. Conclusion ：（1）The result of reduction will influence the outcome of the treatment, the step on articular surface shoud be less than 2 mm after reduction. （2） Nonoperative method is recommended if volar Barton fractures are not associated with subluxation of the carpus. （3）Nonoperative method can be tried first if the fractures associated with the subluxation of the carpus, however operation is recommended when the articular step is more than 2 mm.