外固定支架术治疗桡骨远端不稳定骨折20例

目的:探讨如何减少桡骨远端不稳定性骨折造成的畸形愈合.方法:桡骨远端不稳定性骨折20例,按AO桡骨远端分型:B3型3例,C1型8例,C2型6例,C3型3例.行外固定支架固定术,适当牵伸和牢固固定下维持已复位的骨折直至愈合.结果:平均随访13个月.外固定时间6～8周.术后无钉道感染,无神经血管损伤,无肌腱迟发性断裂等并发症发生,骨折愈合时间8～12周,平均10周.按Dienst功能评定标准评价治疗结果:优18例,良、可各1例.结论:外固定支架应用在桡骨远端不稳定性骨折中,提高了骨折治疗的治愈率,减少了并发症的发生,降低了病残率.     

外固定架结合有限内固定治疗桡骨远端粉碎性骨折

目的:分析闭合复位、外固定器跨腕关节固定结合有限内固定治疗不稳定性桡骨远端骨折的疗效。方法:2006年1月～2010年5月,利用外固定器跨腕关节固定结合有限内固定治疗39例不稳定性桡骨远端骨折。年龄25～73岁,平均53.4岁,其中Colles骨折10例,Smith骨折3例,Barton骨折26例,均保守治疗失败而手术。手法复位或外固定器协助复位,外固定器固定结合有限内固定。随访4～40个月,平均22个月。结果:骨折愈合时间,6～10周,平均8周,均未见钉孔感染。随访时,影像学评估Stewart[1]改良sarmiento评分:优35例,良4。腕关节功能按Dienst[2]功能评估标准:优30例,良6例,可3例,优良率为92.3%。结论:闭合复位、外固定器跨腕关节固定结合有限内固定桡骨远端骨折,有利于术后早期行手部功能锻炼,为不稳定性桡骨远端骨折的有效治疗方法。     

外固定支架治疗桡骨远端不稳定骨折30例体会

目的探讨外固定支架治疗桡骨远端骨折（A3、C2、C3）的临床疗效。方法采用外固定支架治疗桡骨远端不稳定性骨折30例,6～8周拆除外固定支架。结果 30例患者均获得6～12个月随访,平均8个月,所有患者11周均达骨性愈合。依Dienest评分标准：优18例,良10例,差2例,优良率为94%。结论外固定支架加克氏针有限内固定治疗桡骨远端不稳定性骨折具有操作简单、复位满意、固定坚强等优点,能恢复腕关节的结构、增加骨折稳定性,减少固定时间,早期恢复关节功能。     

桡骨远端不稳定性骨折的手术治疗

目的 探讨桡骨远端不稳定性骨折的手术治疗及临床疗效.方法 2002～2005年共手术治疗桡骨远端不稳定性骨折患者62例,男25例,女37例;年龄48～81岁,平均65.5岁.按AO尺桡骨远端骨折分类,B1型5例、B2型10例、B3型8例、C1型15例、C2型16例、C3型8例.行T型接骨板内固定38例,单纯切开复位外固定架固定10例,切开复位外固定架加简单内固定14例.结果 62例患者均获得随访,随访时间4～12个月,平均7.3个月.X线片显示骨折全部愈合,41例关节面平整;掌倾角5°～12°,平均8.2°;尺偏角16°～23°,平均20.2°;桡骨轴向无短缩.根据Aro等功能评价标准,本组结果优29例、良25例、可5例、差3例,优良率达87%.结论 对不同类型桡骨远端骨折,分别采用T形钢板、外固定支架等方式治疗,可达到骨折准确复位及早期恢复腕关节功能的目的.     

超腕关节外支架联合钢板治疗C3型桡骨远端骨折合并尺桡骨干骨折

目的: 探讨超腕关节外支架联合钢板内固定治疗C3型桡骨远端骨折合并尺桡骨干骨折的临床效果。方法： 收集C3型桡骨远端骨折合并尺桡骨干骨折10例（男性7例,女性3例）,利用超腕关节外支架联合钢板内固定治疗,随访观察患者腕关节屈伸、前臂旋转功能及骨折愈合情况。结果： 10例患者获得 6~18个月（平均12个月）的随访,术后3个月腕关节背伸平均70度,掌侧屈曲平均65度;前臂旋前平均70度,旋后平均70度。术后患者均无感染发生,除1例患者术前已表现有正中神经损伤症状外,其余患者术后功能恢复良好,无腕关节僵硬及疼痛发生,骨折愈合良好,无骨不连发生。结论： 超腕关节外支架联合钢板内固定治疗C3型桡骨远端骨折合并尺桡骨干骨折,前臂和腕关节功能恢复快,并发症少,有利于患者早期功能锻炼及骨折愈合,并且方便术后观察、换药和护理。     

动力型外固定支架结合克氏针内固定治疗桡骨远端骨折68例

目的：观察动力型外固定支架结合克氏针内固定治疗桡骨远端骨折的疗效。方法：以外固定支架撑开复位克氏针内固定治疗桡骨远端骨折68例,其中粉粹型骨折66例,横断2例,按AO分型：C1型26例,C2型36例,C3型6例。开放性3例,闭合性65例。结果：经3月-1年随访,X片显示骨折全部愈合,腕关节功能按D ienst功能评分标准评定,优47例,良12例,可10例,差2例,优良率88.2%。结论：动力型外固定支架克氏针治疗桡骨远端骨折,复位满意、固定可靠、功能恢复佳。     

锁定加压钢板与克氏针结合外固定支架治疗桡骨远端复杂关节内骨折的解剖复位及关节功能恢复对比

目的探讨锁定加压钢板与克氏针结合外固定支架治疗桡骨远端复杂关节内骨折的解剖复位及关节功能恢复的效果。方法将我院收治的40例桡骨远端复杂关节内骨折患者作为研究对象,比较采用锁定加压钢板治疗(对照组,20例)与应用克氏针结合外固定支架治疗(观察组,20例)在术后骨折愈合及腕关节评分方面的差异性。结果两组术后骨折愈合及并发症情况比较均无典型差异(P0.05);C1、C2两种类型桡骨远端复杂关节内骨折术后腕关节评分比较无显著差异(P0.05),但C3型骨折对比结果显示观察组明显优于对照组(P0.05)。结论采用锁定加压钢板与克氏针结合外固定支架治疗桡骨远端复杂关节内骨折均可取得较为满意的效果;而C3型骨折采用克氏针结合外固定支架治疗效果更佳,建议优先选用。     

桥式外固定支架治疗桡骨远端不稳定骨折42例疗效分析

目的:探讨闭合复位、单侧桥式外固定支架治疗桡骨远端不稳定骨折的效果。方法:回顾性分析我科2005年7月～2010年6月应用单侧桥式外固定支架治疗42例桡骨远端不稳定骨折患者的临床资料,28例单纯手法牵引复位后行外固定支架固定,14例经皮克氏针撬拨复位固定加外固定支架固定,观察治疗效果。结果:骨折愈合时间6～9周,平均7.8周。5例出现针道浅表感染,经抗炎治疗及局部换药后好转。随访12～48个月(平均19个月),影像学评估(Stewart改良的Sarmiento评分):优32例,良10例。腕关节功能按Gartland与Werley功能评分标准:优29例,良9例,可4例,优良率90%。结论:闭合复位、单侧桥式外固定支架牵引固定桡骨远端不稳定性骨折是安全、有效的治疗方法,并可早期功能调整和训练。     

外固定架治疗桡骨远端爆裂骨折

目的 探讨外固定支架治疗桡骨远端爆裂性骨折的效果．方法 对23例桡骨远端爆裂性骨折病例，ⅣB型13例，ⅣC型10例，采用外固定支架或外固定支架加克氏针治疗．术后随诊并评价疗效。结果 23例随诊6～18个月，优15例，良6例，优良率94．7％。影像学评分，20例优良，3例发生再移位。结论 桡骨远端爆裂骨折采用手法整复外固定架或外固定架加克氏针固定能获得理想的解剖复位和腕关节功能恢复。     

手术治疗不稳定型桡骨远端骨折74例

目的观察不稳定型桡骨远端骨折的手术治疗方法。方法对74例不稳定型桡骨远端骨折采用外固定支架、C形臂X光透视下闭合复位经皮克氏针内固定及切开复位钢板螺钉内固定治疗。结果全部患者均随访1年以上,优良率：外固定支架组为95.3%;闭合性复位经皮克氏针内固定组为79.6%;切开复位钢板螺钉内固定组为84.2%。结论手术治疗不稳定型桡骨远端骨折具有良好的固定作用,能较好地防止骨折畸形愈合和保护腕关节功能。     

掌侧入路保留旋前方肌治疗桡骨远端不稳定骨折的临床研究

目的探讨掌侧入路并保留旋前方肌的钢板内固定技术治疗桡骨远端不稳定骨折的临床疗效。方法从2011年3月至2013年3月,我科对收治的34例桡骨远端不稳定骨折患者进行掌侧入路切开复位钢板内固定术,术中予以保留旋前方肌。34例患者中,男性15例,女性19例;年龄24~76岁,平均57岁。按照AO/OTA分型:A3型4例,B1型3例,B2型11例,B3型10例,C1型6例。结果 术后所有患者获得12~15个月的随访,平均13个月,末次随访时,骨折均愈合。无术后感染、内固定失败及骨折不愈合等并发症发生。根据Gartland-Werley标准评定疗效:优21例,良11例,可2例,优良率94.11％。结论掌侧入路保留旋前方肌的钢板内固定术治疗桡骨远端不稳定骨折能有效减少手术创伤及术后并发症,其疗效满意。     

锁定加压钢板在治疗桡骨远端不稳定骨折中的应用

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 radialfractures,DRF)的效果。方法:分析自2006年1月～2012年5月我院采用锁定加压钢板治疗桡骨远端不稳定骨折20例患者临床资料,其中男12例,女8例;年龄18～66岁,平均年龄44.6岁。按AO桡尺骨远端骨折分型,B2、3型(部分关节面骨折,掌背侧骨块)6例;Cl型(完全关节内骨折,干骺端骨折)7例;C2型(完全关节内骨折,干骺端粉碎骨折)5例;C3型2例。部分患者初期手法复位固定治疗失败。掌侧入路切开复位,LCP内固定治疗。结果:术后门诊随访2～36个月。桡骨远端骨折均完全愈合,按改良的Mcbirde评分和纽约骨科医院腕关节功能评估标准,优良率为85℅(17/20)。结论:对桡骨远端不稳定性骨折,掌侧LCP是一种安全有效的治疗方法。     

桡骨远端不稳定性骨折内固定与石膏外固定比较

目的：探讨桡骨远端不稳定性骨折手术内固定与石膏外固定治疗的临床疗效。方法对98例桡骨远端不稳定性骨折患者按照随机分组的方法选择治疗方案,其中行掌侧T形锁定接骨板内固定53例,闭合复位石膏外固定45例。治疗后6个月分别对手术治疗组与石膏外固定组进行影像学检查及腕关节Gartland-Werley功能评价标准[任国文,吴学元.复杂桡骨远端骨折的手术治疗[J].中国骨与关节损伤杂志,2011,26（3）：254-255．]评分。结果98例患者均获得随访,手术内固定组较石膏外固定组术后影像学检查及腕关节功能评分结果均具有显著性差异（P＜0.05）。结论桡骨远端不稳定性骨折手术内固定优于闭合复位石膏外固定。     

外固定支架治疗高龄桡骨远端粉碎性骨折的疗效分析

目的：观察外固定支架治疗高龄桡骨远端粉碎性骨折患者的疗效。方法回顾性分析2013年9月至2016年3月我院收治的70岁以上采用外固定支架治疗的桡骨远端粉碎性骨折患者47例(48侧),随访6~18个月,术后4个月评价影像学骨折愈合结果,术后6个月评价患肢腕关节功能。结果术后2~4个月46例(47侧)患者骨折一期愈合,1例(1侧)患者延迟愈合;患者平均掌倾角12.3°、尺偏角22°、桡骨高度10.3 mm;影像学结果Lidstrom分级显示：Ⅰ级16例16侧,Ⅱ级19例20侧,Ⅲ级9例9侧,Ⅳ级3例3侧;术后6个月患侧腕关节功能PRWE评分结果显示：优18例19侧,良20例20侧,可6例6侧,差3例3侧,优良率为81.25%;共有6例7侧患者发生钉道感染,2例2侧发生克氏针退针,1例1侧桡骨钉孔处骨折。结论外固定支架治疗高龄桡骨远端粉碎性骨折患者优良率高,并发症少,是一种可靠的治疗方法。     

3D打印技术在桡骨远端不稳定性骨折微创治疗中的应用

目的探讨3D打印技术辅助下微创手术在桡骨远端不稳定性骨折治疗中的临床应用。方法选取桡骨远端不稳定性骨折病人25例,分为3D打印技术辅助下微创（闭合或有限切开）复位克氏针内固定外固定支架外固定组（MIS组）12例和切开复位锁定板内固定组（ORIF组）13例。比较2组病人手术时间和切口长度,术后随访病人腕关节掌屈、背伸、尺偏、桡偏、旋前、旋后六个方向的活动度,复查腕关节正侧位片,观察对掌倾角、尺偏角、桡骨长度及关节面恢复情况,应用Gartland-Werley腕关节功能评分表对2组病人腕关节功能进行评分并比较。结果2组病人均顺利完成手术,MIS组手术时间明显短于ORIF组（P < 0.01）,手术切口长度明显小于ORIF组（P < 0.01）。2组病人术后腕关节均复位良好,腕关节活动度和功能评分优良率差异均无统计学意义（P>0.05）。结论应用3D打印技术辅助下微创（闭合或有限切开）复位克氏针内固定外固定支架外固定治疗桡骨远端不稳定性骨折,切口小,手术时间短,腕关节功能恢复良好,且可避免二次手术。     

Treatment of type C3 distal radius fracture resulted from high-energy injuries by volar plate in combination with external fixator

Background With a type C3 distal radius fracture it is extremely difficult to maintain the reduction and to restore congruity of the articular surface because the support for the volar and dorsal bone cortex has been lost. An external fixator crossing wrist in combination with Kirschner wire (K-wire) fixation was popularly used by most studies in recent years. But loss of reduction often occurred especially in the volar sides. Methods A total of 30 cases of type C3 distal radius fracture were treated by a volar buttress plate combined with a transarticular external fixator and other techniques such as K-wire fixation and bone grafting if necessary. The postoperative volar tilt angles, ulnar inclinations, radial heights, range of motion, grip strength and complications were recorded to assess the therapeutic effects. Results Of the 30 patients, 27 patients were followed up for 12-29 (mean 18) months and all fractures healed in 8-13 weeks after surgery (mean 10 weeks). The wrist function was excellent in 8 cases, good in 16 cases and fair in 3 cases according to the Sarmiento scoring system (modified by Stewart).Conclusions For type C3 comminuted fracture with severe volar and dorsal instability, fixation by volar buttress plate combined with transarticular external fixator should be adopted. Dorsal instability could be further stabilized by other techniques such as Kirschner wire fixation, and bone grafting.     

Treatment of type C3 distal radius fracture resulted from high-energy injuries by volar plate in combination with external fixator

Background With a type C3 distal radius fracture it is extremely difficult to maintain the reduction and to restore congruity of the articular surface because the support for the volar and dorsal bone cortex has been lost. An external fixator crossing wrist in combination with Kirschner wire (K-wire) fixation was popularly used by most studies in recent years. But loss of reduction often occurred especially in the volar sides. Methods A total of 30 cases of type C3 distal radius fracture were treated by a volar buttress plate combined with a transarticular external fixator and other techniques such as K-wire fixation and bone grafting if necessary. The postoperative volar tilt angles, ulnar inclinations, radial heights, range of motion, grip strength and complications were recorded to assess the therapeutic effects. Results Of the 30 patients, 27 patients were followed up for 12-29 (mean 18) months and all fractures healed in 8-13 weeks after surgery (mean 10 weeks). The wrist function was excellent in 8 cases, good in 16 cases and fair in 3 cases according to the Sarmiento scoring system (modified by Stewart).Conclusions For type C3 comminuted fracture with severe volar and dorsal instability, fixation by volar buttress plate combined with transarticular external fixator should be adopted. Dorsal instability could be further stabilized by other techniques such as Kirschner wire fixation, and bone grafting.     

Treatment of type C3 distal radius fracture resulted from high-energy injuries by volar plate in combination with external fixator

Background With a type C3 distal radius fracture it is extremely difficult to maintain the reduction and to restore congruity of the articular surface because the support for the volar and dorsal bone cortex has been lost. An external fixator crossing wrist in combination with Kirschner wire (K-wire) fixation was popularly used by most studies in recent years. But loss of reduction often occurred especially in the volar sides. Methods A total of 30 cases of type C3 distal radius fracture were treated by a volar buttress plate combined with a transarticular external fixator and other techniques such as K-wire fixation and bone grafting if necessary. The postoperative volar tilt angles, ulnar inclinations, radial heights, range of motion, grip strength and complications were recorded to assess the therapeutic effects. Results Of the 30 patients, 27 patients were followed up for 12-29 (mean 18) months and all fractures healed in 8-13 weeks after surgery (mean 10 weeks). The wrist function was excellent in 8 cases, good in 16 cases and fair in 3 cases according to the Sarmiento scoring system (modified by Stewart).Conclusions For type C3 comminuted fracture with severe volar and dorsal instability, fixation by volar buttress plate combined with transarticular external fixator should be adopted. Dorsal instability could be further stabilized by other techniques such as Kirschner wire fixation, and bone grafting.     

Treatment of type C3 distal radius fracture resulted from high-energy injuries by volar plate in combination with external fixator

Background With a type C3 distal radius fracture it is extremely difficult to maintain the reduction and to restore congruity of the articular surface because the support for the volar and dorsal bone cortex has been lost. An external fixator crossing wrist in combination with Kirschner wire (K-wire) fixation was popularly used by most studies in recent years. But loss of reduction often occurred especially in the volar sides. Methods A total of 30 cases of type C3 distal radius fracture were treated by a volar buttress plate combined with a transarticular external fixator and other techniques such as K-wire fixation and bone grafting if necessary. The postoperative volar tilt angles, ulnar inclinations, radial heights, range of motion, grip strength and complications were recorded to assess the therapeutic effects. Results Of the 30 patients, 27 patients were followed up for 12-29 (mean 18) months and all fractures healed in 8-13 weeks after surgery (mean 10 weeks). The wrist function was excellent in 8 cases, good in 16 cases and fair in 3 cases according to the Sarmiento scoring system (modified by Stewart).Conclusions For type C3 comminuted fracture with severe volar and dorsal instability, fixation by volar buttress plate combined with transarticular external fixator should be adopted. Dorsal instability could be further stabilized by other techniques such as Kirschner wire fixation, and bone grafting.     

Treatment of type C3 distal radius fracture resulted from high-energy injuries by volar plate in combination with external fixator

Background With a type C3 distal radius fracture it is extremely difficult to maintain the reduction and to restore congruity of the articular surface because the support for the volar and dorsal bone cortex has been lost. An external fixator crossing wrist in combination with Kirschner wire （K-wire） fixation was popularly used by most studies in recent years. But loss of reduction often occurred especially in the volar sides. Methods A total of 30 cases of type C3 distal radius fracture were treated by a volar buttress plate combined with a transarticular external fixator and other techniques such as K-wire fixation and bone grafting if necessary. The postoperative volar tilt angles, ulnar inclinations, radial heights, range of motion, grip strength and complications were recorded to assess the therapeutic effects. Results Of the 30 patients, 27 patients were followed up for 12-29 （mean 18） months and all fractures healed in 8-13 weeks after surgery （mean 10 weeks）. The wrist function was excellent in 8 cases, good in 16 cases and fair in 3 cases according to the Sarmiento scoring system （modified by Stewart）. Conclusions For type C3 comminuted fracture with severe volar and dorsal instability, fixation by volar buttress plate combined with transarticular external fixator should be adopted. Dorsal instability could be further stabilized by other techniques such as Kirschner wire fixation, and bone grafting.