桡骨远端骨折合并同侧肘关节脱位的损伤机制及手术治疗

目的 探讨桡骨远端骨折合并同侧肘关节脱位的损伤机制和手术方法.方法 2007年12月至2011年4月我院共收治桡骨远端骨折合并同侧肘关节脱位损伤7例.桡骨远端骨折按AO/ASIF分型标准确定:A3型3例,C1型2例,C3型2例.均为肘关节后脱位,其中2例合并有冠状突尖部骨折,为Regan-Morrey分型中的工型.2例合并有前臂筋膜室间隔综合征早期表现.6例行肘关节侧副韧带修复,桡骨远端骨折均行骨折切开复位内固定术,2例经皮下行前臂深筋膜切开减压.结果 术后平均随访时间为16.4个月(9～26个月),无再骨折或脱位,无伤口感染,2例前臂远端伤口二期缝合.7例桡骨远端骨折均在术后6个月内愈合,肘关节稳定,2例肘关节周围出现少量的异位骨化,但不影响肘关节活动.Cooney腕关节评分平均为89.5分(75～100分),其中优2例、良3例、中1例、差1例.Mayo肘关节功能评分平均为90.5分(75～ 100分),其中优4例、良2例、中1例.肩臂手残障问卷表评分(DASH)为5分(2～ 11分).结论 桡骨远端骨折合并同侧肘关节脱位多为高能量损伤,损伤机制为腕关节背伸位,肘关节伸直位,整个上肢受到外翻、旋后和轴向的应力.较易引起前臂筋膜室间隔综合征,通过手术修复损伤的肘关节周围韧带和复位固定桡骨远端骨折可获得良好效果.     

桡骨远端骨折掌侧手术治疗方法的回顾性分析

目的分析比较掌侧入路普通"T"型钢板、锁定加压接骨板(LCP)治疗桡骨远端骨折的疗效,探讨其合理的内固定方法。方法比较两种固定方法在手术时间、骨折愈合时间、并发症发生率以及腕关节功能的结果。结果T型钢板组手术时间(56.3±5.5)min,骨折愈合时间(3.5±1.0)个月,并发症发生率5.8%;LCP组手术时间(52.5±3.1)min,骨折愈合时间(2.8±1.3)个月,并发症发生率3.5%。普通"T"型钢板腕关节功能优良率94.1%,LCP组腕关节功能优良率96.4%。结论对于桡骨远端骨折,掌侧入路是较理想的方式;锁定加压接骨板(LCP)在治疗桡骨远端骨折中有一定优势。     

桡骨远端关节内骨折的手术治疗

桡骨远端骨折约占四肢骨折的15%,其中高能量损伤造成的骨折多呈粉碎性、不稳定性,并累及关节面,对这类患者如治疗不当,会造成腕关节无力、畸形、疼痛,影响日常生活。因此手术恢复关节面的平整、桡骨长度、掌倾角及尺偏角极为重要。我院1999年1月至2004年6月采用手术治疗的桡骨远端关节内骨折32例,报道如下。临床资料1.一般资料:本组32例,男20例,女12例;年龄18~60岁,平均41.2岁;其中高处摔下、车祸等高能量损伤22例,跌倒等低能量损伤10例;按AO分类[1]:B1型2例,B2型2例,B3型3例,C1型10例,C2型7例,C3型8例。均为闭和性。2.手术方法:患肢均…     

切开手术治疗桡骨远端骨折合并TFCC损伤36例

目的 探讨切开手术治疗桡骨远端骨折并TFCC Palmer Ⅰ B型损伤的临床效果.方法 回顾分析2018年2月-2019年5月共手术治疗桡骨远端骨折并TFCC Palmer Ⅰ B型损伤的患者36例,桡骨远端骨折依据AO分型,C1型2例,C2型9例,C3型25例,均合并TFCC Palmer Ⅰ B型损伤.患者伤后3...     

桡骨远端陈旧骨折的手术治疗

1999年1月～2003年4月，我院对18例明显畸形伴有功能障碍的桡骨远端陈旧性骨折采取手术治疗，取得较满意的治疗效果。现报告如下。     

桡骨远端骨折的手术治疗进展

本文查阅了手术治疗桡骨远端骨折的最新文献，报告其重点内容，探讨桡骨远端骨折新近的手术治疗进展。桡骨远端骨折有多种不同的手术治疗方法，包括掌、背侧联合切口双侧内固定，掌侧切开复位钢板内固定，锁定加压钢板内固定，背侧Pi形钢板内固定，支架外固定及关节镜下治疗等，治疗效果都较满意。桡骨远端骨折有众多的亚型，应根据不同的骨折类型选择适当的手术方法，以期获得最佳的疗效。     

合并肘关节脱位的桡骨小头骨折的手术治疗

合并肘关节脱位的桡骨小头骨折较为少见,但却是一种严重的肘关节创伤,如认识不足、诊治有误,会造成不同程度的病残.笔者自1999年3月～2004年5月共收治17例,经随访疗效较为满意.报告如下.     

桡骨远端不稳定骨折的手术治疗体会

桡骨远端骨折系指发生于旋前方肌近侧缘以远部位的骨折,是人体最常发生的骨折之一,约占所有骨折的17%[1]。本院对桡骨远端不稳定骨折进行了手术复位,2003年3月至2008年11月共收治桡骨远端不稳定骨折26例,疗效满意。现总结如下。     

桡骨远端骨折--手术与非手术治疗比较

有一些证据表明外科治疗，包括开放复位内固定(ORIF)或经皮穿针固定(不包括Kapandji穿针)，其功能结果优于保守治疗。不过，仍需要大规模的研究和更长的随访来证实这些结论。     

桡骨远端不稳定骨折的手术治疗

目的比较不同的桡骨远端不稳定骨折的手术疗效和并发症。方法桡骨远端不稳定骨折56例,其中普通T型钢板固定26例,LCP钢板固定8例,克氏针固定22例。植骨者30例,手术均在伤后2周内进行。结果平均随访10·6个月,根据Dienst标准,各组的优良率分别为T型钢板固定92·3%,LCP钢板固定87·5%,克氏针固定90·9%。结论桡骨远端不稳定骨折根据其损伤类型,采用不同的手术方法可取得良好的疗效。在处理严重的桡骨远端不稳定骨折时,LCP钢板与普通钢板没有显著差异。     

青年桡骨远端陈旧性骨折继发下尺桡关节重度脱位的手术治疗

目的 探讨青年桡骨远端陈旧性骨折继发下尺桡关节重度脱位的手术治疗方法.方法 采用短缩尺骨、重建下尺桡关节法,对7例桡骨陈旧性骨折、短缩,下尺桡关节重度脱位患者进行治疗.术后对患者腕关节外形、功能进行随访.结果 所有患者外形恢复良好,功能评价优6例,良1例.结论 短缩尺骨、重建下尺桡关节法是治疗桡骨陈旧性骨折、短缩,下尺桡重度脱位的有效方法.     

急性肘关节后脱位伴尺骨冠状突及桡骨小头骨折手术治疗

急性肘关节后脱位伴尺骨冠状突及桡骨小头骨折是一种较少见的外伤类型,它是一种复杂的肘关节脱位,约占肘关节脱位的10%~20%,因其治疗困难,预后差,被称为肘关节“可怕的三联征”(Terrible traid)[1]。2000年4月-2004年6月,对18例急性肘关节后脱位伴尺骨冠状突及桡骨小头骨折采用     

Simultaneous ipsilateral fractures of distal and proximal ends of the radius

We treated a patient with a rare combination of ipsilateral fractures of the distal and proximal ends of the radius. A woman aged 52 years had simultaneous fractures of the distal and proximal ends of the radius (radial head and neck) after she fell from a high place. The fracture of the radial head was treated by open fixation with a cancellous bone screw, and the fractured distal end of the radius was treated by bone graft, with the subsequent application of an external fixator. At the 1-year follow up, the patient had minor residual limitation of forearm pronation and elbow joint extension, but she had no pain on movement, and had a good result based on Cooney's score (90 points). Received: December 20, 2000 / Accepted: April 4, 2001     

外固定器结合克氏针固定治疗桡骨远端不稳定型骨折

[目的]总结桡骨远端不稳定骨折外固定器结合克氏针固定的手术技巧和疗效。[方法]自2002年10月～2004年6月，48例均采用外固定架结合克氏针骨折端交叉固定，早期功能康复。随访时间6～24个月。[结果]按改良的Mcbride评分标准，远期疗效优良者44例，优良率91．6％。[结论]强调克氏针交叉固定桡骨远端骨折结合外固定器固定，提高了骨折的稳定性，腕关节可中立位固定，避免过度牵引，可早期功能康复，功能评价优于单纯应用外固定器。     

Future treatment and research directions in distal radius fracture

Whether or not they will have their lives dramatically extended in the next few decades, it is clear that people are living longer, healthier, and more active lives. The two peak incidences of distal radius fractures will remain within the pediatric and geriatric age groups, with the latter experiencing a substantial increase in the coming years. This article attempts to project future developments with regard to epidemiology, risk and prevention, fracture assessment, and treatment of distal radius fractures, and the ever increasing concern for the economic impact of this prevalent injury.     

游离腓骨小头移植治疗桡骨远端严重粉碎性骨折

桡骨远端严重粉碎性骨折常合并关青面及骨缺损，临床治疗效果不佳，晚期常留下腕部畸形，严重影响腕部、手部的功能。我们自2001年9月-2003年10月采用自体游离腓骨小头移植重建桡骨远端关节面治疗桡骨远端严重粉碎性骨折11例，经3～12个月随访，疗效较为满意，现总结报告如下。     

桡骨远端不稳定骨折的手术治疗

目的 探讨桡骨远端不稳定骨折的治疗方法及效果。方法 自2000年1月～2004年3月。根据不同的骨折类型分别采用闭合复位经皮克氏针固定、切开复位掌侧支持钢板内固定、闭合复位或有限切开内固定加外固定支架以及切开复位记忆合金内固定治疗桡骨远端不稳定骨折63例66侧。术中进行自体骨移植17侧。结果 63例患者中有58例60侧获随访，随访时间为5～28个月(平均14个月)。腕关节功能按Sarmiento标准进行评定，优27侧，良20侧，可9侧，差4侧。并发症包括钉道感染5侧，骨干部骨不连1侧，腕管综合征1侧，创伤性骨关节炎2侧。结论 桡骨远端不稳定骨折应根据不同的骨折类型采用不同的手术方法，每一种方法应掌握好其适应证。     

Influence of distal radioulnar joint subluxation on restricted forearm rotation after distal radius fracture

PURPOSE: To analyze the influence of subluxation of the distal radioulnar joint (DRUJ) on restricted forearm rotation after distal radius fracture. METHODS: Twenty-two cases of healed unilateral distal radial fracture with restricted forearm rotation were included in the study. The subluxation of the DRUJ was evaluated using helical computed tomography scan at neutral, maximum pronation, and maximum supination and presented as the percent displacement of the ulnar head in both the injured and uninjured sides. The radiographic parameters of palmar tilt, radial inclination, dorsal shift, radial shift, and ulnar variance were measured on plain x-ray films and the rotational deformity of the distal radius was evaluated from the computed tomography scan. The differences of each radiographic parameter from the uninjured side were calculated. The relationships between the restricted forearm rotation and the percent displacement of the ulnar head and each of the radiographic parameters were analyzed statistically. RESULTS: When forearm pronation was restricted the ulnar head was located palmarly at neutral, maximum supination, and maximum pronation with severe dorsal tilt of the distal radius. When supination was restricted the ulnar head was located dorsally at maximum supination with severe ulnar-positive variance. CONCLUSIONS: The subluxation of the DRUJ was related to restricted forearm rotation. The radiographic parameters of palmar tilt and ulnar variance showed an adverse influence on the position of the ulnar head at the DRUJ, which might lead to restricted forearm rotation after distal radial fracture.     

Surgical treatment of fractures of the distal radius with plates: a comparison of palmar and dorsal plate position

Introduction While most fractures of the distal radius can be treated successfully by conservative means, some fractures—especially the more complicated fracture types—require surgical fixation. One of the operative techniques is plate osteosynthesis, which can be performed in either a dorsal or a palmar plate position.Materials and methods This study reports on 122 fractures of the distal radius treated by open reduction and internal fixation with the T-plate, investigating the long-term outcome after an average period of 42.4 months. The follow-up examination contained a subjective, a clinical and a radiological part, and the results were evaluated according to the scores of Stewart and of Castaing with special emphasis on the question of whether palmar or dorsal plating showed any differences in outcome, and if so, what they were.Results The radiological results (Stewart 1 score; i.e. the anatomical reduction) were 'excellent' or 'good' in 87.7% of cases. There were significant differences with respect to age, gender and plate position: patients older than 80 years and women had significantly worse results, and dorsal plating was significantly better than palmar plating. The functional outcome (Stewart 2 score) was 'excellent' and 'good' in 90.2% of cases. These functional results showed a tendency for dorsal plating to be better, but the differences were not significant. There was a close correlation between the radiological and the clinical findings. With the Castaing score, which combines both functional and radiological outcomes, there were 73.8% perfect and good results.Conclusion This study shows that the majority of patients with problem fractures of the distal radius can be successfully treated by internal fixation using the T-plate. The dorsal approach to the distal radius—in cases where dorsal plating is appropriate—will result in a better anatomical reduction and clinical outcome.