闭合手法复位治疗Barton骨折27例

Barton骨折是指通过桡骨远端部分关节面的边缘骨折,且腕关节伴随楔形骨块向掌侧或背侧产生脱位或者半脱位,称为掌侧或背侧Barton骨折。我院自1999-2005年共收治该类骨折27例,采用闭合手法复位结合石膏托外固定,25例闭合复位成功,经随访疗效满意,现报告如下。1临床资料本组27例,均为新鲜骨折,均在受伤后1~2d就诊,男16例,女11例;年龄18~62岁;掌侧型20例,背侧型7例;伴下尺桡关节分离3例,伴尺骨茎突骨折7例。2治疗方法所有患者均采用臂丛神经阻滞麻醉,患者平卧于手术床上,术者位于患侧,双手握住腕关节远端,一助手握住前臂中段部分适当牵引,待腕…     

桡骨远端关节面背侧缘骨折合并桡腕关节背侧半脱位

背景：桡骨远端关节面掌侧缘骨折合并桡腕关节掌侧半脱位（Barton骨折）已普遍被人们所认识，且有大量的资料指导其治疗。而桡骨远端关节面背侧缘骨折合并桡腕关节背侧半脱位（有时称其为背侧或反Barton骨折）很少被提及，且指导其治疗的资料非常少。 方法：评估20例桡骨远端关节面背侧缘骨折合并桡腕关节背侧半脱位的患者，其中2例伴掌侧韧带撕裂；10例伴掌侧缘唇部骨折，有移位及旋转；6例伴关节面掌侧部分嵌插；2例无掌侧损伤。20例中14例关节面中央有碎骨片嵌入。18例患者采用不同的手术入路行背侧支撑钢板重建关节面。在随访时利用X线检查、改良的Mayo腕评分以及臂、肩及手伤残（DASH）问卷评估结果。 结果：在术后平均30个月时，19例骨折愈合且没有明显的对线不良，1例患者在取出钢板后再度出现背侧半脱位。腕和前臂最后的平均活动度为：掌曲59°，背伸56°，旋前87°旋后85°。平均握力为健侧的85％。根据Garfland和Werley的评定方法，最终的功能结果为：优、良18例，可2例。改良Mayo腕评分为平均75分，DASH评分为平均15分。 结论：桡骨远端关节面背侧缘骨折合并桡腕关节背侧半脱位伴系列掌侧损伤，包括韧带损伤、撕脱骨折和关节面嵌插。虽然这些损伤比较复杂，但手术治疗可使大多数患者获得满意的腕关节功能。 可信水平：治疗性研究，Ⅳ级。进一步可信度参见作者介绍。     

陈旧性Barton骨折的治疗

目的 分析陈旧性Barton骨折的原因,探讨其检查与处理方法.方法 对16例陈旧性Barton骨折(掌侧骨折11例,背侧骨折5例),通过x线片检查并结合CT检查确定骨折的类型.关节面的移位程度和腕关节脱位程度.11例掌侧骨折采用掌桡侧切口T型金属板固定,5例背侧骨折采用桡骨远端背外侧切口有限内固定加外固定架固定.结果 术后随访时间为10～36个月,平均12.5个月.X线片显示骨折全部愈合,腕关节面掌倾角为10°～15°,平均11.3°;尺偏角16°～25°,平均20°;桡骨轴向无短缩.按Mehara功能评价:优13例,良2例,可1例;优良率为93.8%.结论 切开复位内固定术是治疗陈旧性Barton骨折的一种积极而有效的方法.CT检查对Barton骨折的诊断、了解关节面的移位情况、确定手术复位及固定可靠程度有一定的临床意义.     

手法复位小夹板分期治疗桡骨远端关节面背侧缘粉碎性骨折伴桡腕关节脱位

目的探讨采用手法复位小夹板分期治疗桡骨远端关节面背侧缘粉碎性骨折伴桡腕关节半脱位或全脱位的临床疗效。方法对桡骨远端关节面背侧缘粉碎性骨折伴桡腕关节脱位26例进行手法复位小夹板外固定分期治疗。结果所有患者获得随访10-38个月,20例骨折愈合且无明显的对线不良,6例出现骨折移位或桡腕关节半脱位,其中4例进行手术修复,2例拒绝手术治疗,采用非手术治疗。腕关节和前臂最后平均活动度为：掌屈62°,背伸54°,桡偏27°,尺偏25°,旋前85°,旋后75°。最后评估时所有患者的每个指尖均可顺利地触及远侧掌横纹。平均为健侧握力的80%。根据Gartland和Werley评分：优14例,良9例,可3例。结论利用韧带整复原理非手术治疗桡骨远端关节面背侧缘粉碎性骨折伴桡腕关节半脱位或全脱位可使大多数患者恢复满意的疗效,但围治疗期处理同样非常重要。     

骨外固定支架治疗Barton骨折脱位11例报告

Barton骨折是指桡骨远端掌侧或背侧缘骨折 ,并有腕关节的掌侧和背侧脱位或半脱位 ,分为掌侧型和背侧型。其治疗方法与 Colles骨折或 Smith骨折常有混肴。治疗效果并不尽相同。我科自 1995年以来将采用骨外固定器治疗 Barton骨折 ,收到满意效果。报告如下。临床资料一、一般资料　本组 11例 ,男性 7例 ,女性 4例 ,年龄最大 6 3岁 ,最小 2 0岁 ,平均 43岁。发生原因为车祸伤 6例、骑自行车摔伤 3例、坠落伤 1例、行走滑倒 1例。掌侧型 8例 ,背侧型 3例。腕关节脱位 2例 ,半脱位 9例。桡骨远端骨折块粉碎者 7例 ,合并尺骨茎突骨折 4例 ;尺骨…     

掌侧T形解剖钢板治疗Barton骨折

Barton骨折是指通过桡骨远端部分关节面的边缘骨折,且腕关节随楔形骨块向掌侧或背侧产生移位,称为掌侧或背侧Barton骨折。本院自2004年5月至2007年12月处理掌侧缘形Barton骨折12例,采用掌侧T形解剖钢板手术治疗,临床取得较满意疗效。     

Colles骨折合并桡腕关节背侧半脱位发生机制的实验研究

作者在２０例尸体标本上通过切断不同的韧带和桡骨远端截骨，并对每一实验拍片记录，研讨Ｃｏｌｌｅｓ骨折中合并桡腕关节背侧半脱位的发生机制及解剖基础。实验研究结果表明：正常情况下桡月角的改变对中点移位是有影响的，但不产生桡腕关节背侧半脱位。产生桡腕关节背侧半脱位的两个主要因素是桡腕关节掌背侧韧带损伤及桡骨远瑞骨折并掌倾角成负角。Ｃｏｌｌｅｓ骨折合成桡腕关节背侧半脱位的患者治疗时要尽量恢复原有的掌倾角，争取解剖复位，复位后在掌屈尺偏位仍有桡腕关节背侧半脱位者，腕关节可固定中立位或轻度背伸位。     

巴尔通骨折手法复位与固定方法

巴尔通骨折为桡骨下端涉及桡骨关节面的骨折,同时有桡腕关节脱位.1939年巴尔通最早叙述,他报告了两种类型:一种腕向背侧脱位骨折块向背侧和近侧移位称背侧型;另一种腕向掌侧脱位骨折块向掌侧和近侧移位,称掌侧型[1].本骨折手法复位不易保持对位,常需手术复位,用小四孔钢板螺钉内固定[2].笔者自1997年以来,运用非手术方法治疗巴尔通骨折11例,取得了满意的效果.     

掌侧型Barton骨折5例

我院自1990年以来共收治Barton骨折掌侧型5例,经随访治疗效果良好,现报告如下。 1 临床资料 1.1 一般资料 本组5例,男性4例,女性1例,右侧3例,左侧2例,年龄17～54岁,平均30岁。致伤原因:均为跌倒后腕关节背伸位着地所致。X线显示,1例为桡骨远端掌侧关节面下陷,倾斜,尤如歪蝎状,桡腕关节掌侧半脱位,其余4例均为桡骨远端掌侧三角形骨片伴桡腕关节掌侧半脱位。 1.2 治疗方法 手术恢复内固定3例,2例给于拉力螺钉加支柱钢板固定,对于关节面塌陷1例,我们给于钢板螺钉固定外,同时给于关节面植骨,非手术治疗2例,给于手法复位,腕关节屈曲位石膏托固定。 1.3 随访结果 本组5例均获随访,随访时间6～30个月,平均14个月,全部骨折均获骨性愈合,骨折愈合时间6～10周,平均8周。根据Oliveiral功能评定标     

空心螺钉微创治疗Barton掌侧型骨折

目的探讨空心螺钉微创技术治疗Barton掌侧型骨折的疗效。方法应用空心螺钉微创治疗15例Barton掌侧型骨折患者。结果15例Barton掌侧型骨折均获骨性愈合,骨折愈合时间4～6周。未出现骨折块移位、螺钉松动病例,腕关节功能良好。结论空心螺钉微创治疗Barton掌侧型骨折可有效避免传统治疗导致腕管综合征的可能,操作简单,创伤小,疗效确切。     

掌侧锁定接骨板联合背侧钛网内固定治疗桡骨远端关节面粉碎性骨折

背景:桡骨远端关节面骨折常需要手术治疗,单纯采用掌侧锁定接骨板入路难以复位背侧关节面或骨碎块。目的:探讨应用掌侧锁定接骨板联合背侧钛网内固定治疗桡骨远端关节面粉碎性骨折的疗效。方法:回顾性分析2007年2月至2011年1月我院收治的23例(男9例,女14例)Barton氏骨折,患者行掌背侧联合内固定手术,术后分别采用Stewart改良的Sarmiento评分方法行影像学评估,Fernandez评分标准进行腕关节功能评分。结果:23例患者获得8~12个月随访,平均10个月,影像学评定,优16例,良4例,可3例。腕关节功能评分,优17例,良4例,可2例。结论:该手术方法治疗Barton氏骨折可有效防止复位丢失、避免肌腱磨损、实现早期功能锻炼。     

Dorsal Cortical Breaks in Volar Barton Distal Radius Fractures

Background: Volar Barton fractures involve the volar articular margin of the distal radius with proximal and volar subluxation of the carpus. Although traditionally conceptualized as partial articular, some volar Barton fractures are complete articular injuries due to a dorsal cortical break in the distal radial metaphysis. While dorsal cortical breaks can affect surgical strategy, they may be difficult to identify on plain radiographs and their epidemiology remains poorly characterized. Some authors have hypothesized an association with osteoporosis; however, this hypothesis remains untested. To better characterize volar Barton fractures, we analyzed fracture geometry on pre-operative computed tomography (CT) scans to: (1) determine the frequency of a dorsal cortical break; and (2) test the null hypothesis that a dorsal cortical break is not associated with age or gender. Methods: We retrospectively reviewed adults with a volar Barton distal radius fracture and an available pre-operative CT who underwent surgical fixation. Using multivariable logistic regression, we assessed whether age or gender was an independent predictor of a dorsal cortical break. Results: Forty patients (mean age 52 years, 57% female) were identified. Including the shaft as a fragment, 32 (80%) had 3 or more discrete fracture fragments. Thirty patients (75%) had a dorsal cortical break. Dorsal cortical breaks were not associated with either age or gender (P > 0.05). Conclusions: Most (75%) patients with volar Barton distal radius fractures had a dorsal cortical break. Dorsal cortical breaks were not statistically associated with age or gender, suggesting these fracture patterns may not be associated with osteoporosis as previously hypothesized.     

Radiocarpal fracture--dislocation

Radiocarpal fracture-dislocation was associated with fracture of the distal articular surface of the radius in five patients (six extremities). Closed manipulation resulted in satisfactory reduction of both the dorsal dislocation of the carpus on the distal radius and displaced articular fracture fragment(s) in two of four extremities. In four extremities, open reduction was necessary as the only means of satisfactorily managing this severe wrist injury. Direct visualization through a dorsolateral incision alone allows for maximal restoration of the often extensive bony injury of the dorsal articular surface of the radius. A volar incision is required for anatomic reduction of the carpus, and median reconstitution of the radiocarpal ligament nerve decompression. Functional results were generally satisfactory; however, radiographic degenerative changes appearing early portend traumatic arthritis as a sequela of this complex injury.     

Volar Barton's fractures with concomitant dorsal fracture in older patients

PURPOSE: To describe a variant of Barton's volar articular shearing fracture of the distal radial articular surface with a subtle concomitant fracture of the dorsal metaphyseal cortex. METHODS: This fracture pattern was observed in 6 women and 2 men with an average age of 67 years (range, 58-76 years). All 8 patients were treated with a volar plate and screws. The dorsal metaphyseal fracture was not recognized in 5 patients and a volar buttress plating technique using an intentionally undercontoured volar plate was used. In 3 patients the dorsal fracture line was identified before surgery and the plate was contoured to fit the volar surface of the distal radius. RESULTS: All 5 patients treated with an undercontoured plate had loss of the normal palmar tilt of the distal radius (average,-9.4 degrees; range, 0 degrees to-22 degrees ) and dorsal translation of the distal radial articular fragments. For the entire group the palmar tilt averaged-5.9 degrees (range, 0.0 degrees to-22.0 degrees ), the ulnar inclination 19 degrees (range, 10 degrees -23 degrees ), and the ulnar variance-0.9 mm (range, 0.0 to-3.0 mm). All patients attained forearm supination of 80 degrees and the average pronation was 75 degrees (range, 45 degrees -80 degrees ). According to Sarmiento's modification of the system of Gartland and Werley there were 1 excellent, 6 good, and 1 fair results. The average Patient-Rated Wrist Evaluation score was 16 (range, 0-35). CONCLUSIONS: Some fractures with an oblique volar marginal articular fracture of the distal radius and volar radiocarpal subluxation (known as Barton's fracture) may also have a fracture through the dorsal metaphyseal cortex. Failure to identify this fracture line can lead to dorsal translation and angulation of the distal radius articular surface, particularly when an undercontoured volar plate is used for internal fixation.     

掌侧斜T型钛板固定治疗严重移位Barton骨折

目的 探讨应用掌侧入路结合斜T型钛板固定治疗严重移位桡骨远端Barton骨折的疗效.方法 对11例严重移位桡骨远端Barton骨折,采用掌侧入路,腕关节面严格解剖复位后,行掌侧斜T型钛板固定.结果 术后随访6个月至3年,平均23.6个月,骨折均在术后3～4个月内愈合.根据腕关节功能评分标准(Gartland-Werley评分)评定:优8例,良2例,可1例;优良率为90.9%.按PRWE评分均在30分以内.结论 对严重移位桡骨远端Barton骨折,应采用手术方法治疗,经掌侧入路结合斜T型钛板固定治疗,可明显缩短治疗时间.     

肩胛骨骨折的手术治疗

目的探讨肩胛骨骨折的临床特征及手术疗效。方法对于2002年3月至2007年3月本院手术治疗不稳定肩胛骨骨折共20例的临床资料进行回顾性分析。按照Miller分型方法Ⅰ—A2例，Ⅰ—B1例，Ⅱ—C1例；Ⅱ-A2例，Ⅱ一B2例，Ⅱ—C5例。Ⅲ2例，Ⅳ5例。根据骨折类型选择手术入路（后入路17例，前入路3例），内固定物分别或结合应用“K”钢板，重建钢板，拉力螺钉固定骨折。结果全部病例均获随访，随访6月～28月，平均14月。根据Hercovici疗效标准，术后肩关节的功能评分为4～16分，平均14．5分，优良率为92．8％。结论手术治疗不稳定肩胛骨骨折能使患者早期功能锻炼，改善肩关节功能。     

Case Reports: Volar Marginal Articular Fractures with Loss of Articular Apposition

Five patients with a volar marginal articular fracture with dislocation (complete loss of apposition of the articular surfaces) were treated with open reduction and internal plate fixation. This is an unusual type of volar shearing fracture and represents the volar type of radiocarpal fracture–dislocation. The results of treatment were comparable to other volar shearing type fractures.     

闭合复位经皮小切口交锁髓内针内固定治疗股骨干骨折

目的：研究闭合复位经皮小切口交锁髓内针内固定治疗股骨干骨折的手法手术联合技术和临床疗效。方法：自2006年1月至2010年12月,96例纳入观察,男67例,女29例;年龄16～88岁,平均39岁。骨折根据AO分型：A型29例,B型46例,C型21例。采用正骨手法和经皮小切口植入技术进行治疗,并对骨折术后功能进行评价。结果：所有患者获随访,时间12～24个月,患者均达到骨性愈合,平均愈合时间4个月（3～10个月）.按Thorsen等股骨骨折术后形态评估系统评价：优87例,良7例,中2例,差0例。结论：充分运用髓内针的设计特点,结合闭合正骨手法复位,能在更小的创伤条件下完成股骨干骨折的治疗,疗效满意。     

Neglected trans-scaphoid trans-styloid volar dislocation of the lunate. Late result following open reduction and K-wire fixation

A rare case of radiocarpal dislocation is presented. The lunate and proximal pole of the scaphoid were displaced in a volar and proximal direction. The injury was missed initially and the patient was subsequently operated on six weeks later. Open reduction and internal fixation of the scaphoid was performed and this was followed by an uneventful postoperative period, with a satisfactory functional outcome at the eight-year follow-up, despite carpal instability non-dissociative-dorsal intercalated segmental instability configuration of the carpus. We believe that although open reduction in neglected cases carries the potential risks of avascular necrosis and nonunion of the affected carpal bones, an attempt should be made to restore the anatomy of the carpus.