锁定加压钢板治疗不稳定型桡骨远端骨折

目的 探讨锁定加压钢板(locking compression plate，LCP)治疗不稳定型桡骨远端骨折( distal radial fractures，DRF)的效果。方法 自2006年1月至2008年12月收治不稳定型桡骨远端骨折82例，其中男33例（2例为双侧），女49例；年龄17～74岁，平均51岁。45岁以上患者中骨质疏松29例，骨量减少21例。骨折根据AO/OTA分型标准：A3型7例，B1型4例，B2型12例，B3型10例，C1型16例，C2型21例，C3型12例。本组61例单纯掌侧入路LCP固定，12例单纯背侧入路LCP固定，5例掌、背侧联合入路掌侧LCP桡侧1/3管状钢板固定，4例掌、背侧联合入路双侧LCP固定。其中辅助外固定支架或克氏针固定19例，尺骨骨折固定7例，骨移植恢复骨缺损39例。结果 术后随访12 ～ 48个月，平均20.7个月。术后并发症包括切口周围出现水泡3例，感染1例，正中神经损伤3例，螺钉过长穿入伸肌间隔4例，骨折复位丢失，螺纹穿入桡腕关节2例，排异反应1例，骨折不愈合1例，创伤性关节炎7例。根据Cooney腕关节评分标准：优56例，良19例，可6例，差1例，优良率为91％。结论 LCP治疗不稳定型DRF安全有效，能够坚强固定，允许早期功能锻炼，尤其适用于骨折压缩粉碎性骨质疏松患者。

Locking compression plate for treatment of unstable distal radius fractures

Objective To explore the application and outcome of locking compression plate in the treatment of unstable distal radius fracture.Methods From January 2006 to December 2008,eighty-two patients with consecutive unstable distal radius fractures were preformed with open reduction and locking compression plate fixation by volar, dorsal or bilateral approaches. There were 31 males (bilateral fractures in two patients) and 49 females with an average age of 51 years (range, 17-74 years).According to AO/OTA criterion, there were seven patientswith type A3 fractures, four with type B 1, 12with type B2, 10 with type B3, 16 with type C1, 21 with type C2 and 12 with type C3. The locking plate fixations through simple volar approach was performed in 61 patients, fixations through dorsal approach in 12, volar 1/3 radius cylindrical steel plate fixation through volar and dorsal approach in five, bilateral fixations through volar and dorsal approaches in four. Furthermore, the external fixator was used in 19 patients, fixation of the ulna fractures in seven, and bone graft in 39. Results The patients were followed up for average 20.7 months ( range, 1-4 years), which showed postoperative complications including bubble appearing around the incision in three patients, infection in one, median nerve injury in three, screws penetrating into extensor compartment in four, threads penetrating into radiocarpal joint because of reduction loss in two, rejection in one and traumatic arthritis in seven. According to the Cooney criterion, the result was excellent in 56 pateints, good in 19, fair in six and poor in one, with excellence rate of 91％. Conclusions The locking compression plate can provide firm fixation and allow early functional exercise and hence is suitable for unstable distal radius fracture especially the osteoporosis patients with comminuted compression fracture.