锁定加压接骨板治疗桡骨远端骨折

目的 总结应用锁定加压接骨板（locking compression plate，LCP）治疗桡骨远端骨折的临床效果。方法 对23例桡骨远端骨折（按AO桡骨远端骨折分类：属A2型4例，A3型3例，B1型2例，B3型2例，C1型7例，C2型2例，C3型3例）的患者，应用锁定加压接骨板行内固定治疗，术后进行早期功能锻炼。结果 术后随访4～25个月，采用腕关节功能及X线片测量指标进行综合评定：优13例，良8例，差2例，优良率达91．2％。结论 采用LCP治疗桡骨远端骨折，具有良好的手术效果，但同时需强调微创技术。     

掌侧锁定加压接骨板治疗桡骨远端不稳定性骨折

目的评价切开复位锁定加压接骨板（LCP）内固定治疗桡骨远端不稳定性骨折的效果。方法对21例桡骨远端不稳定性骨折采用掌侧入路切开复位LCP内固定治疗。其中5例做了植骨。结果21例均获随访,时间6～19（13．0±3．9）个月,患者骨折均愈合。桡骨远端的掌倾角平均9．6°±3．7°;尺偏角平均21．4°±2,3°;桡骨短缩≥2mm2例,其余皆〈2mm;关节面移位均〈1mm。用改良的Gartland和Werley评分系统评估腕关节功能：优14例,良5例,中1例,差1例。结论切开复位掌侧LCP内固定是治疗桡骨远端不稳定性骨折的有效方法,辅以植骨能有效防止关节面塌陷和促讲骨折愈合。     

锁定接骨板内固定治疗桡骨远端不稳定型骨折

目的 探讨掌侧解剖型锁定接骨板(LCP)内固定治疗桡骨远端不稳定型骨折的方法及疗效.方法 对39例桡骨远端不稳定型骨折采用掌侧切开复位解剖型LCP内固定治疗,术后结合早期功能锻炼.结果 37例患者获得术后随访,平均随访13个月,应用改良Mcbride腕关节功能评价标准进行术后疗效评价,优21例,良12例,可3例,差1例,优良率达89.1%.结论 掌侧切开复位解剖型LCP内固定治疗桡骨远端不稳定型骨折,能有效恢复关节解剖关系,固定牢靠,结合早期功能锻炼,有利于患肢功能恢复.     

掌侧锁定加压接骨板(LCP)治疗老年桡骨远端骨折

目的评价掌侧入路锁定加压接骨板(LCP)治疗老年人骨质疏松性桡骨远端骨折的疗效。方法对30例Melone分型2B以上的老年骨质疏松患者的桡骨远端骨折采用掌侧入路,LCP钢板固定进行手术治疗。通过对这些患者术后腕关节功能随访、X线片观察等分析,评定该方法的疗效。结果经术后平均2.1年随访,30例患者中26例术后没有腕关节疼痛,能满足日常生活要求,患者对治疗效果满意。2例术后仍存在腕关节疼痛且需服用止痛药。2例存在手指活动障碍。术后X线片显示桡骨远端关节面平均掌倾3.38°,尺倾18.9°,桡骨茎突较尺骨茎突长0.9cm。2例桡骨远端较术后早期X线片缩短0.2cm。未发现其它严重并发症。结论老年人骨质疏松性桡骨远端骨折(Melone2B型以上)采用掌侧LCP内固定是有效的手术方法之一,对恢复并维持桡骨远端高度和关节面不失为一种较好的选择。     

掌侧锁定加压接骨板(LCP)治疗桡骨远端不稳定骨折

目的报告切开复位锁定加压接骨板(LCP)内固定治疗桡骨远端不稳定骨折的效果及其评价。方法2002年4月～2004年5月,对46例桡骨远端不稳定性骨折采用掌侧入路切开复位LCP内固定进行治疗。其中14例做了植骨,12例术后用掌侧石膏托支持。结果术后所有患者随访6～30个月(平均21个月),所有骨折均愈合。桡骨远端的掌倾角平均9.7°;尺偏角平均21.3°;桡骨短缩≥2mm4例,其余皆<2mm;关节面移位均<1mm。用改良的Gartland和Werley评分系统评估腕关节功能,优32例,良11例,中2例,差1例;优良率为93.5%。结论切开复位掌侧LCP内固定是治疗桡骨远端不稳定性骨折的有效方法,辅以植骨能有效防止关节面塌陷和促进骨折愈合。     

掌侧锁定加压接骨板治疗老年桡骨远端骨折

目的 评价掌侧入路锁定加压接骨板(LCP)治疗老年骨质疏松性桡骨远端骨折的疗效.方法 应用LCP掌侧入路治疗52例老年桡骨远端骨折患者.结果 患者均获随访,时间6～24(15 ±9)个月.骨折均愈合,时间4～8(6±2)个月.桡骨远端关节面掌倾角为0°～12°,尺偏角为10° ～28°.桡骨茎突较尺骨茎突长0.70 ～1.20 cm.腕关节功能按Sarmiento评估标准进行评分:优27例,良18例,可7例,优良率达86.5％.结论 掌侧LCP内固定治疗老年骨质疏松性桡骨远端骨折固定可靠,退钉率低,可早期恢复腕关节功能,是恢复并维持桡骨远端高度和关节面一种较好选择.     

锁定加压接骨板治疗老年桡骨远端不稳定骨折

目的探讨锁定加压接骨板治疗老年桡骨远端不稳定骨折的疗效。方法采用锁定加压接骨板治疗48例老年桡骨远端不稳定骨折患者。结果 48例均获随访,时间6～12个月。骨折均愈合,愈合时间4～10个月。无感染、肌腱断裂、螺钉松动、骨折再错位及骨不愈合等并发症。疗效评定按Gartland-Werley评分标准:优30例,良13例,可5例。结论锁定加压接骨板治疗老年桡骨远端不稳定骨折固定可靠,可早期进行功能锻炼,能最大限度恢复腕关节功能,临床疗效满意。     

T形锁定加压接骨板治疗桡骨远端骨折

目的探讨T形锁定加压接骨板治疗桡骨远端骨折的临床效果。方法对21例按AO分类为B型和C型的桡骨远端骨折患者,应用T形锁定加压接骨板进行内固定治疗。结果19例获得随访,时间4～10（6.5±1.9）个月。骨折全部愈合,愈合时间6～12（7.4±1.3）周。根据改良Mcbride腕关节功能评价标准：优12例,良5例,差2例。结论采用T形锁定加压接骨板治疗桡骨远端骨折具有固定可靠,尤其对不稳定的骨折患者具有良好的治疗效果,并有利于患肢早期的功能锻炼。     

DVR解剖型桡骨掌侧锁定接骨板治疗桡骨远端关节内骨折

2009年11月～2011年2月,我院采用切开复位DVR解剖型桡骨掌侧锁定接骨板内固定治疗20例桡骨远端关节内骨折患者,取得满意疗效。1材料与方法1.1病例资料本组20例,男11例,女9例,年龄25～75岁。骨折AO分型:     

锁定加压接骨板治疗桡骨远端骨折

2007年7月～2009年6月,我院采用腕掌侧入路、斜T形锁定加压接骨板(LCP)治疗桡骨远端骨折22例,取得了较为满意疗效.     

Results in treatment of distal femur fractures using polyaxial locking plate

Indications and techniques of locked plate fixation for the treatment of challenging fractures continue to evolve. As design variant of classic locked plates, the polyaxial locked plate has the ability to alter the screw angle and thereby, enhance fracture fixation. The aim of this observational study was to evaluate clinical and radiographic results in 89 patients with 90 fractures of the distal femur treated, between June 2006 and November 2011, with such a polyaxial locked plating system (Polyax™ Locked Plating System, DePuy, Warsaw, IN, USA). Seventy-seven fractures formed the report of this study. These cases were followed up until complete fracture healing or for a mean time of 77 weeks. At the time of last follow-up, 58 of 77 fractures (75.3 %) progressed to union without complication and radiographic healing occurred at a mean time of 16.3 weeks. Complications occurred in ten fractures that did not affect the healing and in nine fractures that showed delayed or non-union. The mean American Knee Society Score at the time of final follow-up was 83 for the Knee Score and 71.1 for the Functional Score. In conclusion, there is a high union rate for complex distal femoral fractures associated with a good clinical outcome in this series.     

Volar plate versus k-wire fixation of distal radius fractures

The optimal management of distal radius fractures remains controversial. The aim of this study was to compare the radiographic and functional outcomes of 318 patients who underwent k-wire fixation or volar plating for fractures of the distal radius. Patients were aged between 20 and 65 years and followed for a mean of 32 months. The mean values for volar tilt, radial inclination, radial length and ulnar variance were all significantly better in the volar plate group. Malunion occurred in 13.2% of patients undergoing k-wiring and 4% of patients treated with a volar plate (p < 0.007). Higher values for radial inclination, radial length and volar tilt correlated with better functional outcome as measured by disabilities of the arm shoulder and hand (DASH) and patient rated wrist evaluation (PRWE) scores. Lower values for ulnar variance correlated with better functional outcome. Although volar plate treatment resulted in a superior radiological outcome, there was no evidence that this translated into a superior functional outcome (DASH 13.12 vs. 11.25, p = 0.28) (PRWE 17.56 vs. 16.31, p = 0.69). The k-wiring procedure remains a suitable inexpensive option for simple fractures. Volar plating should be reserved for complex fractures that cannot be reduced by closed means.     

Mono- versus polyaxial locking plates in distal femur fractures: a prospective randomized multicentre clinical trial

Purpose

Treatment of complex fractures of the distal femur utilizing monoaxial locking plates (e.g. Less Invasive Stabilisation System, LISS®, Synthes) is considered to be superior to conventional plating systems. Due to the limitation that the thread forces the screw into pre-determined positions, modifications have been made to allow screw positioning within a range of 30° (Non Contact Bridging, NCB®-DF, Zimmer). For the first time, this multicenter prospective randomized clinical trial (RCT) investigates the outcome of LISS® vs. NCB®-DF treatment following complex fractures of the distal femur.

Methods

Since June 2008, 27 patients with a fracture of the distal femur (AO ASIF 33-A-C and periprosthetic fractures) were enrolled in this study by four university trauma centres in southern Germany. Clinical (e.g. range of motion, Oxford knee score, Tegner score) and radiological (e.g. axis deviation, secondary loss of realignment) follow-ups were conducted one and six weeks, as well as three, six, and 12 months after the operation.

Results

This study comprises data of 27 patients (8 male, 19 female; 15 NCB®-DF, 12 LISS®). Polyaxial osteosynthesis using the NCB® system tended to result in better functional knee scores and a higher range of motion. Interestingly, fracture union tended to be more rapid using the polyaxial plating system.

Conclusions

We present the analysis of a multicenter prospective RCT to compare the monoaxial LISS® vs. the polyaxial NCB®-DF treatment following complex fractures of the distal femur. NCB®-DF treatment tended to result in better functional and radiological outcomes than LISS® treatment.

Level of Evidence

Level I     

T型锁定加压接骨板与远端万向锁定加压接骨板治疗桡骨远端骨折的疗效分析

目的 比较使用T型锁定加压接骨板和远端万向锁定加压接骨板在治疗桡骨远端骨折时的手术疗效.方法 回顾性分析2011年12月-2015年11月于首都医科大学附属北京友谊医院骨科分别采用T型锁定加压接骨板与远端万向锁定加压接骨板治疗桡骨远端骨折的118例患者病例资料.T型锁定加压接骨板组60例;按AO/OTA分型,其中A3型3例,B2型5例,B3型7例,C1型10例,C2型20例,C3型15例.远端万向锁定加压双柱接骨板组58例;按AO/OTA分型,其中A3型1例,B2型2例,B3型4例,C1型15例,C2型18例,C3型18例.分析对比两组术后影像学参数、功能恢复情况.随访以门诊随访进行.掌倾角、尺偏角、桡骨高度、腕关节背伸、掌屈、尺偏、桡偏、旋前、旋后角度以及Gartland-Werley功能评分用均数±标准差((x)±s)表示,组间比较行￡检验.结果 所有患者术后均得到随访,T型锁定加压接骨板组平均随访时间26.5个月,远端万向锁定加压双柱接骨板组平均随访时间25.6个月.结果显示,在尺偏角、桡骨高度、桡偏角度以及Gartland-Werley功能评分方面两组间差异无统计学意义,在掌倾角、腕关节背伸、掌屈、尺偏、旋前、旋后角度方面两组间差异有统计学意义,远端万向锁定加压接骨板具有优势.结论 采用两种内固定手术方式治疗桡骨远端骨折均获得满意的临床疗效,远端万向锁定加压接骨板更具有优势,临床手术应用可根据患者具体情况选择相应的内固定方式.     

新型锁定加压钢板治疗老年桡骨远端C型骨折

目的 探讨新型2.4 mm锁定加压钢板(LCP)治疗老年桡骨远端C型骨折的初期疗效.方法 回顾性分析2006年10月至2008年11月采用新型2.4 mm LCP治疗21例老年桡骨远端C型骨折患者,男7例,女14例;年龄71～85岁,平均76岁.骨折按AO分型:C1型6例,C2型13例,C3型2例,均为闭合性骨折.所有患者均经掌侧入路复位固定,术中不显露背侧组织,骨缺损严重行置入人工骨.结果 所有患者获平均10.6个月(8～27个月)随访.X线片示骨折全部一期愈合,平均愈合时间为8周.2例骨缺损严重者,术中植入人工骨.所有患者均无感染、骨不连、钢板松动、腕管综合征等并发症发生.术后功能康复时间4～36周,平均11周.腕关节活动度:背伸23°～84°,平均71.3°;掌屈33°～86°,平均72.0°;尺偏19°～29°,平均26.3°;桡偏12°～30°,平均19.9°;前臂旋前60°～87°,平均79.5°;旋后52°～80°,平均76.4°.与健侧对比,握力减弱3例,活动后疼痛3例.按改良的Mcbride腕关节功能评价标准:优14例,良5例,可2例,优良率为90.5%.结论 新型2.4 mm LCP治疗老年骨质疏松引起的桡骨远端C型骨折,内固定坚强,可以早期功能锻炼,疗效佳.     

Biomechanical comparison of a lateral polyaxial locking plate with a posterolateral polyaxial locking plate applied to the distal fibula

BackgroundPolyaxial locking plates are becoming popular for the fixation of distal fibula fractures. This study establishes how construct stiffness and plate loosening, measured as range of motion, differs between lateral and posterolateral plate location.MethodsSeven matched pairs of cadaver fibulae were osteotomized in standardized fashion to produce a Weber type B distal fibula fracture. The fragments were fixated with an interfragmentary lag screw and polyaxial locking plates, with one fibula in each pair receiving a posterolateral anti-glide-plate, and the other a lateral neutralization-plate. In a biomechanical test, the bending and torsional stiffnesses of the constructs and the ranges of motion (ROM) were measured and subjected to a paired comparison.ResultsThe laterally plated group had a higher median (interquartile range) bending stiffness (29.2 (19.7) N/mm) and a smaller range of motion (2.06 (1.99) mm) than the posterolaterally plated group (14.6 (20.6) N/mm, and 4.11 (3.28) mm, respectively); however, the results were not statistically significant (p_bending = 0.314; p_ROM = 0.325). Similarly, the torsional stiffness did not differ significantly between the two groups (laterally plated: 426 (259) N mm/°; posterolaterally plated: 248 (399) N mm/°; p_torsion = 0.900). The range of motion measurements between the two groups under torsional loading were also statistically insignificant (laterally plated: 8.88 (6.30) mm; posterolaterally plated: 15.34 (12.64) mm; p_ROM = 0.900).ConclusionIn biomechanical cadaver-model tests of Weber type B fracture fixation with polyaxial locking plates, laterally plated constructs and posterolaterally plated constructs performed without significantly difference. Therefore, other considerations, such as access morbidity, associated injuries, patient anatomy, or surgeon's preference, may guide the choice of plating pattern. Further clinical studies will be needed for the establishment of definitive recommendations. Clinical relevance: Information on the behavior of polyaxial locking plates is relevant to surgeons performing internal fixation of distal fibula fractures.     

Comparison of treatment of unstable intra articular fractures of distal radius with locking plate versus non-locking plate fixation

Introduction

Unstable intra articular fractures of distal radius are frequently being managed with open reduction and internal fixation. Of late in some biomechanical studies locking plates have been shown to be better in terms of maintenance of radiological parameters in comparison to non-locking plates. We conducted this study to know whether this biomechanical superiority of locking plates is converted in to better clinical outcomes.

Materials and methods

A study was conducted in 60 patients (30 in each group) with unstable intra articular fractures of distal radius who were treated by open reduction and internal fixation with locking plates and non-locking plates. Patients were evaluated for radiological parameters (intra articular step off, radial height, radial tilt, volar tilt) and functional parameters (flexion, extension, radial deviation, ulnar deviation, pronation, supination grip strength) at two year follow up. Overall outcome was evaluated by scoring systems of Gartland and Werley and modified Green O'' Brien.

Results

The change in radiological parameters from immediate post op to latest at two year in locking plate group was not significant for radial height, radial tilt, volar tilt, but ulnar variance whereas in non-locking plate there was significant change in radial height, volar tilt, ulnar variance but no significant change in radial inclination. In clinical and functional outcome no significant difference was found at two year follow up.

Conclusions

Locking plates maintain the radiological parameters better than non-locking plates but functional outcome are same for both plates at two year after surgery.     

锁定加压钢板内固定治疗中老年女性桡骨远端粉碎性骨折

目的探讨锁定加压钢板(LCP)内固定治疗中老年女性桡骨远端粉碎性骨折的疗效。方法自2002年3月～2004年10月,使用LCP治疗中老年女性桡骨远端粉碎性骨折32例35侧,平均年龄65岁。AO分型A3型11侧,C2型15侧,C3型9侧。32侧采用掌侧入路,3侧采用背侧入路;5侧进行植骨。结果所有患者得到随访,随访10～41个月,平均21.5个月。骨折愈合时间3～5个月。按Dienst功能评估标准进行评定:优13侧,良19侧,可2侧,差1侧,优良率为91.4%。伤口延迟愈合及浅表感染5侧,术后正中神经压迫症状2侧。结论LCP内固定治疗桡骨远端粉碎性骨折具有固定可靠、退钉率低、并发症少的优点,特别适合骨质疏松的中老年女性桡骨远端粉碎性骨折的内固定。     

掌侧入路锁定加压钢板内固定治疗老年桡骨远端骨质疏松性骨折

目的探讨T形锁定加压钢板治疗老年桡骨远端骨质疏松性骨折的初期疗效。方法总结2003年6月～2005年5月T形锁定加压钢板内固定治疗老年桡骨远端骨质疏松性骨折13例,男4例,女9例;年龄67～81岁,平均74岁。按AO分类标准:B2型2例,B3型3例,C1型2例,C2型5例,C3型1例,均为闭合性骨折。所有病例均采用掌侧入路,术中不显露背侧组织,骨缺损严重者置入人工骨(Osteoset)。术后功能康复时间6～30周,平均12.3周。术后第1天开始被动活动腕关节,1周后主动活动,功能锻炼。结果13例全部获得随访,平均13.2个月(4～22个月)。X线片显示骨折全部一期愈合,平均愈合时间为7周。所有病例均无感染、骨不连、钢板松动、腕管综合征、正中神经炎等并发症。按改良的Mcbride腕关节功能评价标准:优9例,良3例,可1例,优良率为92.3%。结论T形锁定加压钢板治疗老年骨质疏松引起的桡骨远端骨折,内固定牢靠,可以早期功能锻炼,减少了因长期固定而导致的骨量丢失,避免腕关节的僵硬程度,疗效佳。     

AO新型锁定内固定系统治疗不稳定型桡骨远端骨折的疗效观察

目的 探讨AO新型2.4 mm锁定内固定系统治疗不稳定型桡骨远端骨折的临床疗效.方法 2007年5月至2008年10月,应用AO 2.4 mm锁定内固定系统治疗115例(120侧)小稳定型桡骨远端骨折患者,其中5例为双侧骨折.骨折按AO分型:A型35侧(A2型7侧,A3型28侧),B型15侧(B1型3侧,B2型8侧,B3型4侧),C型70侧(C1型42侧,C2型20侧,C3型8侧).开放伤110例,按Gustilo-Anderson分型:Ⅰ型6例,Ⅱ型4例.采用单纯掌侧锁定加压钢板(LCP)固定78侧,单纯背侧LCP固定16侧,背侧加桡背侧联合固定26侧.结果 98例患者获得随访,其中3例为双侧骨折患者,随访率为84.2%.随访时间为6～15个月,平均8个月.X线片示所有患者骨折均达到骨性愈合,无术后感染、内固定松动、背侧肌腱激惹、正中神经刺激症状发生.患者腕关节活动度平均为背伸54°,掌屈58°,旋前72°,旋后760°.根据Sarmiento改良的Garland & Werley评分方法评定疗效:优55侧,良32侧,可14侧,优良率为86.1%.结论 AO 2.4 mm锁定内固定系统可为多种类型的桡骨远端骨折提供个体化的内固定选择,且骨折复位、固定满意,患者腕关节功能预后良好.

Abstract：

Objective To observe the clinical outcome of AO 2.4 mm locking plate system used for unstable distal radius fractures. Methods From May 2007 to October 2008, 115 patients (5 cases of both sides) with unstable distal radius fractures were managed by AO 2.4 mm locking plate system. There were 35 fractures of type A, 15 type B and 70 type C according to AO classification. Of them, 10 fractures were open, with 6 of type 1 and 4 of type 2, according to Gustilo-Anderson Classification. Volar plating was conducted in 78 cases, dorsal plating in 16 cases and dorsal + radial plating in 26 cases. Results Ninety-eight patients (3 cases of both sides) were followed up for an average of 8 (range, 6 to 15) months. The follow-up rate was 84.2%. Radiographic bone union was achieved in all cases without infection, implant loosening, or tendon and median nerve irritations. The average ROM was 54°, 58°, 72°, and 76° for dorsi-extension, palmer flexion, pronation and supination respectively. According to Gartland & Werley Scores modified by Sarmiento, there were 55 excellent cases, 32 good and 14 fair, with an excellent to good rate of 86.1%. Conclusion AO 2.4 mm locking plate system can offer individualized fixation regimen for unstable distal ra-dius fractures, leading to satisfactory fracture reduction and fixation with predictable clinical outcomes.