有限切开克氏针有限内固定结合外固定支架治疗桡骨远端粉碎骨折

目的探讨有限切开克氏针有限内固定结合外固定支架治疗桡骨远端粉碎骨折的疗效。方法采用有限切开克氏针有限内固定结合外固定支架治疗桡骨远端粉碎骨折19例。结果 19例均获随访,时间5~20个月。骨折均获得愈合。影像学评估采用Stewart改良的Sarmiento评分系统：优10例,良8例,可1例。腕关节功能评估采用Gartland与Werley标准：优12例,良5例,可2例。结论有限切开克氏针有限内固定结合外固定支架治疗桡骨远端粉碎骨折,能有效恢复桡骨远端骨性结构的解剖并维持骨折稳定,创伤较小,利于腕关节功能的恢复,临床疗效满意。     

外固定支架结合克氏针固定治疗桡骨远端不稳定性骨折

目的观察外固定支架结合克氏针固定治疗桡骨远端不稳定性骨折的临床疗效。方法对42例桡骨远端不稳定性骨折采用切开复位克氏针联合外固定支架治疗。结果 42例患者均获12~18个月的随访,平均14.6个月,患者均获骨性愈合。骨折愈合时间5~9周,平均6.9周。未发生钉道感染、神经血管损伤,腕关节僵硬及骨不连等。依据Dienst标准评价术后腕关节功能,优26例,良12例,可4例,优良率90.48%。结论对桡骨远端不稳定性骨折实施外固定支架结合克氏针固定治疗,创伤小、操作简单、固定牢靠,术后腕关节功能优良率高。     

可调节外固定支架结合有限内固定治疗C型桡骨远端骨折的临床观察

目的观察采用可调节外固定支架结合克氏针有限内固定治疗C型桡骨远端骨折的临床疗效。方法有完整随访资料桡骨远端骨折病人22例,根据AO/ASIF分型标准:C1型6例、C2型7、C3型9例,均采用可调节外固定支架结合克氏针有限内固定手术治疗。通过随访病人术后X线资料及检查腕关节功能恢复情况,评定疗效。结果随访6~18个月,平均13个月,X线片显示,所有骨折均在3个月内愈合,根据Garland-werley标准评定腕关节功能:优15例,良5例,可2例,优良率90.91%。结论采用可调节外固定支架结合克氏针有限内固定治疗C型桡骨远端骨折,能较好恢复并维持桡骨高度、掌倾角、尺偏角,可获得满意的腕关节功能。     

外固定支架结合有限内固定治疗老年桡骨远端骨折

目的:探讨外固定支架结合有限内固定治疗老年桡骨远端骨折的疗效及并发症.方法:回顾32例60岁以上桡骨远端骨折外固定支架结合有限内固定术后病人,随访10～44个月,用Gartland与Werley评分评价术后功能.结果:评分,优11例,良17例,可3例,差1例,优良率为87.5%.手术并发症7例,占21.9%.结论:外固定支架结合有限内固定治疗老年桡骨远端骨折疗效可靠,并发症少.     

桡骨远端关节内粉碎性骨折内外联合固定的手术疗效

[目的]探讨桡骨远端关节内粉碎性骨折的有效治疗方法.[方法]21例C3型桡骨远端骨折病例,应用开放复位外固定架联合钢板或克氏针内固定手术方法,根据放射线检查,Gartland & Werley 和改良Green & O′Brein 评分系统,对手术前、手术后以及术后远期腕关节功能进行评价,并对手术解剖复位情况和功能恢复进行统计学分析.[结果]经随访6～36个月(平均19个月),术后远期伤侧腕关节活动范围为健侧78%,手握力为健侧82%,桡关节面存在台阶及骨折分离间隙平均2 mm,桡骨远端长度恢复平均11 mm.根据Gartland & Werley 和改良Green & O′Brein 评分系统,远期功能分别为优5例和3例,良12例和9例,一般4例和2例,差0例和2例.术后关节面的解剖复位与功能预后明显相关.[结论]开放复位外固定架联合钢板或克氏针内固定是保证复位满意,稳定复位效果,取得术后远期满意功能恢复的有效治疗方法.     

有限切开复位克氏针内固定结合外固定支架治疗桡骨远端粉碎性骨折

目的探讨有限切开复位克氏针内固定结合外固定支架治疗桡骨远端粉碎性骨折的效果。方法回顾性分析周口永善医院骨科2018-01—2019-12间收治的48例桡骨远端粉碎性骨折患者的临床资料。男18例,女30例;年龄37~73岁。AO分型:B2型7例,B3型6例,C1型14例,C2型16例,C3型5例。均予以有限切开复位克氏针内固定结合外固定支架治疗。术后观察骨折愈合时间、随访期间的并发症,及末次随访时的腕关节功能。结果本组手术时间为(34.14±12.69)min,术后骨折愈合时间为(8.07±1.76)周。术后患者均获8个月随访,其间出现钉道感染1例、克氏针退出2例,并发症发生率为6.25%。未发生创伤性关节炎、桡神经受损、骨折延迟愈合等其他并发症。末次随访时依据腕关节功能Dienst评分标准:本组患者腕关节功能优良率为91.67%(44/48)。结论有限切开复位克氏针内固定结合外固定支架治疗桡骨远端粉碎骨折,创伤小,操作简单,术后并发症少,腕关节功能恢复效果可靠。     

外固定支架辅以有限内固定治疗复杂桡骨远端骨折

[目的]回顾分析外固定支架辅以有限内固定治疗复杂桡骨远端骨折的疗效。[方法]2011年6月²013年6月,本院采用外固定支架辅以有限克氏针内固定治疗复杂桡骨远端骨折86例,男39例,女47例;年龄212013年6月,本院采用外固定支架辅以有限克氏针内固定治疗复杂桡骨远端骨折86例,男39例,女47例;年龄21⁸4岁,平均42.5岁。骨折按AO分型:C2型34例,C3型52例。术中采用可调组合式外固定支架辅以经皮克氏针固定骨折端,骨折愈合后拆除外固定支架。[结果]86例患者均得到随访(884岁,平均42.5岁。骨折按AO分型:C2型34例,C3型52例。术中采用可调组合式外固定支架辅以经皮克氏针固定骨折端,骨折愈合后拆除外固定支架。[结果]86例患者均得到随访(8²4个月,平均11.5个月),骨折愈合时间1024个月,平均11.5个月),骨折愈合时间10¹3周,平均11.5周。影像学评估采用Sarmiento评分系统:末次随访时优62良24;腕关节功能按Gartland-Werlry功能评分标准,优良率91%。本组病例中无严重并发症(桡神经损伤,第二掌骨医源性骨折等)发生。[结论]外固定支架辅以有限内固定治疗复杂桡骨远端骨折,能最大程度地减轻手术创伤,在为骨折端提供满意的复位和坚强固定的同时,还能最大限度保护骨折端周围的血供,为骨折愈合提供良好的生物学环境;术后并发症少,患肢功能恢复满意,是一种有效的治疗方法。     

外固定架及横向克氏针固定治疗下尺桡关节失稳桡骨远端骨折疗效分析

目的探讨采用外固定架及横向克氏针固定治疗下尺桡关节失稳桡骨远端骨折的临床疗效。方法回顾性分析自2009-03—2013-05采用外固定架及横向克氏针固定治疗的45例背侧皮质塌陷缺损、下尺桡关节失稳的桡骨远端骨折。采用Cooney评分系统进行疗效评价。结果 45例均获得随访6~12个月,平均7.5个月。所有患者骨折均愈合,愈合时间2.5~4个月,平均2.7个月。末次随访时采用Cooney评分系统评定腕关节功能:优18例,良24例,可3例,优良率93.3%。结论采用外固定架及横向克氏针固定治疗下尺桡关节失稳桡骨远端骨折能有效恢复术后患者的腕关节功能。     

外固定支架联合克氏针固定治疗桡骨远端骨折临床效果观察

目的探讨外固定支架联合克氏针固定对桡骨远端骨折患者的临床应用效果。方法回顾性分析2018-06—2019-11间杞县人民医院采用外固定架联合克氏针固定的43例桡骨远端骨折患者的临床资料。男25例,女18例;年龄25~65岁,平均43.02岁。AO分型:A2型3例,A3型4例,B1型3例,B2型4例,C1型5例,C2型11例,C3型13例。臂丛麻醉下安装并调整好外固定支架,行手法牵引复位。C臂X线机透视机确认复位满意后,拧紧各个锁固螺母固定关节,将不稳定的骨折块以克氏针固定。记录手术时间、术中出血量。术后随访6个月,统计骨折愈合时间。末次随访评价腕关节功能恢复效果。结果43例患者均达到理想的解剖复位,手术时间为(67.21±4.98)min、术中出血量为(21.30±7.16)mL、骨折愈合时间为(9.14±2.48)周。末次随访,腕关节功能优良率为90.70%,腕关节背伸、掌屈、旋前及旋后活动度均优于术前,差异有统计学意义(P<0.05)。结论外固定架联合克氏针固定治疗桡骨远端骨折,具有创伤小、操作简单、固定牢固等优势,利于促进骨折愈合及腕关节功能恢复。     

手术治疗桡骨远端骨折的预后及影响因素分析

目的 探讨手术治疗桡骨远端骨折的预后并分析其影响因素. 方法 1999年1月至2008年7月手术治疗桡骨远端骨折104例(105侧),使用锁定加压钢板63侧,T形钢板40侧,克氏针1侧,克氏针加外固定架1侧.采用影像学评分、Gartland & Werley评分评价疗效,并分析其影响因素. 结果所有患者随访3～72个月,平均25个月.根据Batra影像学评分:优60侧,良37侧,可5侧,差3侧,优良率92.4%(97/105).年龄<65岁患者的影像学评分优于年龄≥65岁患者(P=0.013).根据Gartland & Werley评分:优84侧,良20侧,可1侧,优良率99.0%(104/105).骨折分型为轻型患者的Gartland & Werley评分优于骨折分型严重的患者(P=0.046).术中复位满意患者的Gartland & Werley结果为优的可能性是欠满意者的3,6倍(P=0.042).结论 切开复位板钉内固定治疗桡骨远端骨折可以取得良好的疗效.年龄是术后影像学评分的影响因素,骨折分型和术中复位情况可以对术后功能评分产生影响.     

Treatment of distal radius fractures with external fixation: technical considerations for rehabilitation

Wrist external fixation with or without K-wire stabilization has been shown to be a reliable treatment method for unstable fractures of the distal radius. The technique of external fixation of the wrist has been historically based on the premise that fracture reduction can be achieved and maintained using the principles of ligamentotaxis. It is now well recognized that sustained longitudinal traction applied with a wrist external fixator can lead to complications. This review outlines the authors' preferred technique of using the external fixator as a neutralization device rather than as a traction device. The absence of sustained radiocarpal traction during distal radius fracture healing may facilitate postoperative rehabilitation.     

背侧钢板辅助固定桡骨远端月骨窝背侧骨折块

目的：探讨背侧钢板辅助固定桡骨远端月骨窝背侧骨折块的临床疗效。方法：自2019年1月至2022年1月,采用背侧钢板辅助固定30例桡骨远端月骨窝背侧骨折块患者,其中男13例,女17例;年龄42~68(48.7±5.6)岁;骨折参照Doi分型:3块型24例,4块型6例。术中透视背侧钢板固定前后桡骨远端掌倾角度数,术后观察骨折愈合和腕关节功能恢复情况,术后12个月采用Gartland和Werley评分系统进行功能评价。结果：所有患者获得随访,时间12~13(11.3±0.9)个月。骨折全部愈合,时间4~5(4.7±0.8)个月。背侧钢板固定前、后桡骨远端掌倾角中位数(P25,P75)分别为5.30°(4.85°,6.03°)、12.45°(11.98°,13.43°),差异有统计学意义(P<0.01)。术后12个月Gartland和Werley评分(1.1±0.4)分,优27例,良3例。结论：背侧钢板辅助固定有利于月骨窝背侧骨折块的复位和掌倾角的恢复。     

Dynamic vs static external fixation of distal radial fractures: A randomized study

Objectives:

The present randomized study is conducted to compare the functional and anatomical outcomes of dynamic multiplanar external fixation against that of static external fixation in the management of displaced unstable comminuted fractures of the distal radius.

Materials and Methods:

Sixty adult patients with displaced unstable comminuted fractures of the distal radius were randomly allocated either to the dynamic (n=30) or static (n=30) fixator groups. Patients in the dynamic fixator group were managed with closed reduction and application of Penning-type articulated fixator (Orthofix, Srl, Italy); the injured wrist was partially dynamized at 3 weeks. Patients in the static group were managed with monoplanar static external fixator of Joshi''s external stabilizing system (JESS) type fixator. In both groups, the fixator was maintained for 6–8 weeks. The patients were followed-up over 2 years. The primary outcome measures were the functional outcome as measured using the Gartland and Werley and DASH scores and anatomical outcome as measured using the Lindstrom score. The secondary objective was to correlate anatomical and functional outcomes and to look at overall local complications.

Results:

Palmar tilt was better restored in the Penning fixator group (P<0.0001). There was reduced loss of ulnar tilt (P=0.05) and radial height (P=0.04) in the Penning fixator group. Gartland and Werley score was better in the Penning fixator group at each time point of the follow-up. The DASH score was similar in the two groups at 2 years (P=0.14). There was poor correlation (0.19) between functional outcome and anatomical restoration at 2 years.

Conclusions:

In the management of displaced unstable comminuted fracture of the distal radius, use of an articulated multiplanar external fixator, allowing partial dynamization of the injured wrist at 3 weeks, resulted in improved early functional and anatomical outcome as compared to static external fixation. However, there was no significant difference in functional outcome at 2 years.     

Complications and functional outcome following fixation of complex, intra-articular fractures of the distal radius with the AO Pi-Plate

This study investigates the efficacy of the AO Pi-plate in the treatment of complex, intra-articular fractures of the distal radius. We retrospectively analysed the clinical and radiological results of 19 consecutive patients who underwent open reduction and internal fixation for dorsally displaced, intra-articular fractures of the distal radius using the AO Pi-plate. The final functional outcome was assessed using the Gartland & Werley scoring system. The average follow-up period was 34.3 months. Wrist movement was restored to a near normal range in all the patients. The functional outcome as measured by the Gartland & Werley scoring system showed excellent and good results in 15 (88%) of the patients. The implant was removed in 4 (23%) of the patients due to extensor tenosynovitis and restriction of flexion. This study demonstrates that although the functional outcome following fixation of complex distal radius fractures with the AO Pi-plate is good, there is a risk of developing extensor tenosynovitis and limitation of flexion. We recommend that the implant be used sparingly and if used then elective removal of the implant should be considered after fracture union.     

Plaster cast compared with bridging external fixation for distal radius fractures of the Colles' type

We compared two different treatments for displaced distal radius Colles' type fractures (Older type 3 and 4), at two hospitals. We found bridging external fixation superior to reduction and fixation in a dorsal plaster cast regarding both the end-anatomic results at 3 months and the functional scores at 3 and 9 months (modified Gartland and Werley).     

掌侧锁定接骨板与外固定架固定治疗不稳定桡骨远端关节内骨折的疗效比较

目的比较掌侧锁定接骨板与外固定架固定治疗不稳定桡骨远端关节内骨折的临床疗效。方法回顾性分析自2015-01—2018-03诊治的78例不稳定桡骨远端关节内骨折,47例采用掌侧锁定接骨板固定手术治疗(锁定板组),31例采用外固定架手术治疗(外固定组)。比较2组手术时间、并发症情况,以及末次随访时关节塌陷情况、DASH评分、Gartland-Werley评分、握力、屈曲度、背伸度、旋前度、旋后度、桡侧倾斜度、尺侧倾斜度。结果 78例均顺利完成手术,随访时间12~32个月,平均16.2个月。锁定板组手术时间较外固定组长,差异有统计学意义(P<0.05)。2组并发症情况比较差异无统计学意义(P>0.05)。末次随访时2组DASH评分、Gartland-Werley评分、握力、腕关节背伸度、旋后度、桡侧倾斜度以及尺侧倾斜度比较差异无统计学意义(P>0.05);锁定板组在屈曲度、旋前度表现较外固定组更好,关节塌陷数较外固定组少,差异有统计学意义(P<0.05)。结论掌侧锁定接骨板手术治疗不稳定性桡骨远端关节内骨折能更好地恢复腕关节的屈曲和旋前功能,维持关节面平整性,但并不能减少并发症以及获得更好的功能评分;医师应综合考虑骨折分型、关节面塌陷以及患者的需求,选择合适的手术方法。     

影响AO掌侧锁定加压接骨板治疗桡骨远端骨折疗效因素的随访研究

目的 通过分析AO掌侧锁定加压接骨板(locking compression plate LCP)治疗桡骨远端骨折的随访结果,探讨影响掌侧LCP治疗桡骨远端骨折疗效的因素.方法 对2004年7月-2007年10月,在我科采用AO掌侧LCP治疗的55例桡骨远端骨折患者进行随访.随访内容包括测量腕关节运动范围及握力,应用Gartland/Werley腕关节评分法和DASH上肢功能评定标准进行评分.结果 55例患者获得6～44个月的随访(平均17.3个月),骨折均愈合.疗效按Cartard/Werley腕关节评分:优32例,良10例,可12例,差1例,优良率76.4%;DASH上肢功能评定得分为[(9.3±13.8)分,x±s,下同].≤55岁组DASH评分为(9.2±15.6)分,Cartland/Wedey腕关节评分为(3.8 4±5.2);＞55岁组DASH评分为(9.4±11.2)分,Gartland/erley腕关节评分为(4.8±5.1);两组间差异无统计学意义(P＞0.05).单纯桡骨远端骨折组DASH评分为(4.9±6.4)分,Gaaland/Wedcy腕关节评分为(2.7±3.8);伴有尺侧损伤或严重局部软组织损伤组DASH评分为(14.1±18.0)分,Gartland/Werley腕关节评分为(5.9±6.0);两组间差异有统计学意义(P＜0.05).结论 AO掌侧LCP治疗桡骨远端骨折的固定效果好,配合适当的术后功能锻炼,可取得良好的疗效.采用AO掌侧IEP作内固定在≤55岁和＞55岁两个年龄组中腕关节功能恢复相近,而伴有尺侧损伤或严重局部软组织损伤者功能恢复较差.     

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。     

Open reduction and internal fixation of displaced, comminuted intra-articular fractures of the distal end of the radius

The results in sixteen patients who had a displaced, comminuted intra-articular fracture of the distal end of the radius and who were treated by open reduction and internal fixation were retrospectively reviewed. At a mean follow-up of 4.8 years, 81 per cent of the patients had a rating of good or excellent by the scoring system of Gartland and Werley, but only 56 per cent had such a rating when the modified scoring system of Green and O'Brien was used. All of the fractures healed at an average of nine weeks. A step-off of two millimeters or more in the distal radial articular surface at the time of healing was important, because the four patients in whom the fracture healed with this amount of incongruity all had post-traumatic arthritis at follow-up, compared with only three of twelve in whom the incongruity was less than two millimeters.