动力性外固定支架和闭合复位治疗桡骨远端关节内移位骨折的疗效比较

目的 回顾性分析和比较动力性外固定支架(dynamic external fixation，DEF)与闭合复位石膏外固定两者治疗桡骨远端关节内移位骨折的疗效评价。方法 对96例急性桡骨远端关节内移位骨折患者，49例应用动力性外固定支架、47例采用闭合复位石膏外固定治疗。结果 治疗后均随访1年。96例桡骨远端关节内骨折，按AO分型属B型或C型骨折复位评分及Lidstrom功能评分标准评定：(1)石膏固定组：复位评分：优良率为44．7％，一般为36．2％，差者19．1％。功能评分：优良率为46．8％，一般为31．9％，差者21．3％。(2)动力性外固定支架组：复位评分：优良率达95．9％，一般及差仅占4．1％。功能评分：优良率为91．8％，一般及差为8．2％。结论 动力性外固定支架组的复位和功能评分明显优于石膏组，是治疗桡骨远端关节内严重移位、粉碎性骨折的好方法。     

手法间接复位掌侧锁定板固定治疗桡骨远端C3型骨折

目的 ：探讨手法间接复位后AO 2.4 mm桡骨远端锁定板联合经皮穿针固定治疗C3型（AO/OTA分型）桡骨远端骨折的临床疗效及操作技巧。方法：自2009年5月至2012年3月采用手法间接复位AO 2.4 mm桡骨远端掌侧锁定板联合经皮穿针固定治疗桡骨远端骨折AO/OTA分型C3型患者19例21腕（双侧2例）。年龄31~66岁,平均（45.3±17.4）岁;并发尺骨茎突骨折14腕,下尺桡关节不稳6腕;均为闭合性骨折;发病时间4.5~9 d,平均（6.7±3.5）d。采用Henry切口显露骨折部位,保留关节囊、韧带连续性,手法间接复位,C形臂X线透视关节面复位情况,仍存在塌陷者予以撬拨复位后桡骨远端掌侧锁定板固定。下尺桡关节发现不稳定和并发尺骨茎突骨折者均予前臂旋后位石膏托固定6周。结果：19例（21腕）获得随访,时间7~17个月,平均10.5个月。X线示患者桡骨远端骨折均达到骨性愈合,尺骨茎突骨折未愈合3例,下尺桡关节不稳0例,1例出现背侧伸肌腱激惹,内固定取出后激惹消除。术后随访观测患者掌倾角、尺偏角、桡骨茎突高度、关节面和下尺桡关节情况,按照Batra和Gupta评分标准行影像学评定：70分以下3腕,70~79分5腕,80分以上13腕。同时对患者进行主观和客观疗效评定,观测残留畸形和腕关节活动度、并发症情况等,根据Sarmiento改良的Gartland-Werley评分系统评定术后疗效：优17腕,良3腕,可1腕。结论：AO/OTA分型C3型桡骨远端骨折手法间接复位可获得良好复位效果,应用锁定板联合穿针可为其提供内固定架支撑式固定以满足早期功能锻炼要求,患腕功能预后良好。     

桡骨远端关节内骨折的分类与关节镜下复位固定

目前的桡骨远端骨折分类方法有一个共同的缺陷，即没有详细描述关节面的解剖改变。基于CT断层扫描和三维重建技术，根据关节面骨块的数目，日本的土井一辉(Doi)教授将桡骨远端关节内骨折分为3型，即2，3、4块型。此分类法简单但直观准确描述了关节面的结构改变，对关节镜操作非常实用。根据此分类，针对不同的骨折类型，采用腕关节镜辅助下的复位固定，以期达到关节面移位小于1mm的复位和固定效果。1992～2003年，91例桡骨远端关节内骨折患者接受关节镜手术，年龄21～79岁。其中42例为2块型，占46％；34例3块型，占37％；15例4块型，占17％。关节镜用于复位后检查14例，引导克氏针13例，辅助复位固定61例，其中4例改为开放复位内固定。固定方法包括外固定架联合克氏针或钢板、钢板联合拉出钢丝或螺钉，6例单用克氏针，1例单用螺钉。长期的功能随访结果表明，与其它传统方法相比，桡骨远端关节内骨折采用关节镜辅助的复位固定可获得更好的关节活动度和握力。     

T型接骨板治疗桡骨远端不稳定骨折45例早期疗效分析

目前治疗桡骨远端骨折的方法很多，包括手法复位外固定、闭合复位外固定架固定、切开复位克氏针内固定、切开复位板钉内固定等。大多数桡骨远端关节外的简单骨折手法复位石膏外固定可获得满意疗效，对不稳定的桡骨远端粉碎骨折，尤其关节内骨折，单纯关节固定很难做到关节面良好的对位和稳定的固定，从而造成桡腕及桡尺关节骨性关节炎、握力下降、顽固性腕关节疼痛等并发症。因此对桡骨远端不稳定骨折诊断及治疗的研究日益受到各国学者重视。     

两种不同方法治疗桡骨远端骨折88例疗效分析

目的探讨桡骨远端骨折不同治疗方法的效果。方法对88例桡骨远端骨折,采用手法复位石膏固定或小夹板固定的60例,切开复位锁定钢板内固定28例。结果 88例骨折全部愈合,按Dient功能评定标准,手法复位优良率78.3%,切开复位优良率85.7%。两组功能比较差异有统计学意义(P<0.01),两组在AO分型中C型骨折的治疗中差异有统计学意义(P<0.05),手术治疗明显优于非手术治疗。结论桡骨远端骨折根据应骨折不同类型采用不同治疗方法。     

桡骨远端骨折的治疗策略

桡骨远端骨折是常见骨折，也是容易受到忽视的骨折，治疗不当会产生明显的功能受限。我们根据桡骨远端骨折的AO分型，对不同骨折类型采取不同的治疗方案，并对患者进行随访，评价治疗效果，进而提出对此骨折的治疗方案。手法复位石膏托外固定适用于AO分型中A型和B1型的桡骨远端骨折。普通AO板钉固定的手术指征主要有3点：①AO分型中的A型骨折手法复位失败者，②AO分型中的B型骨折关节面移位明显者，③AO分型中的C1、C2型和部分C3型骨折。LCP板钉固定适于伴有严重骨质疏松的桡骨远端骨折和AO分型中的C2、C3型骨折。外固定架固定适用于粉碎性而无法行板钉固定的桡骨远端骨折。     

桡骨远端经关节面骨折的手术治疔

目的探讨桡骨远端关节内骨折手术治疗的效果。方法14例桡骨远端关节内骨折根据AO/ASIF分型,B2型3例,B3型2例,C1型5例,C2型3例,C3型1例。分别采取外固定支架、外固定支架加克氏针、掌侧或背侧支持钢板固定。结果随访8~20个月,平均12个月,优良率为92.7%。结论桡骨远端的关节内骨折在闭合复位欠佳时,应该考虑手术治疗,根据骨折类型采用不同的手术方式,可取得满意的效果。     

外固定架结合内固定治疗桡骨远端关节内骨折

目的探讨外固定支架结合内固定钢板治疗桡骨远端关节内骨折的手术指征及临床疗效。方法23例桡骨远端关节面骨折患者,根据AO分型标准分类,C2型8例,C3型15例。采用外固定支架固定,结合钢板内固定。结果23例均获得随访,随访时间6～18个月,平均10.5个月。X线片示骨折均愈合,桡骨长度无丢失。掌倾角8°～16°,平均12.5°;尺偏角19°～28°,平均21.8°,均无丢失。根据Gartland等评分标准结合X线片所测参数,本组优20例,良3例。结论外固定支架结合钢板内固定治疗桡骨远端关节内骨折可获满意复位及功能。     

超关节外固定支架治疗桡骨远端C型骨折

目的研究超关节外固定支架治疗桡骨远端AO分型C型骨折的疗效。方法采用超关节外固定支架治疗桡骨远端C型骨折3l例。结果治疗后平均随访6．5个月。骨折愈合时间平均为6．5周。根据Jakim评分标准评定疗效，优14例，良12例，优良率为83．87％。结论超关节外固定支架治疗不稳定型桡骨远端关节内骨折具有操作简单、复位满意、固定坚强、功能优良的优点。     

切开复位内固定治疗桡骨远端关节内骨折移位

切开复位内固定治疗桡骨远端关节内骨折移位何志晶何洪生摘译苗旭漫审校采用切开复位，Ｔ—钢板内固定治疗３１例复位困难或闭合复位失败的桡骨远端关节内骨折。随访时间４年（３～７年）。术后腕关节掌侧倾斜角、桡骨下端长度、关节对合及关节内骨折片的复位均明显改善...     

桡骨远端关节内骨折的手术治疗

目的 探讨桡骨远端关节内骨折的手术治疗及临床效果。方法手术治疗桡骨远端关节内骨折患者35例。按AO／ASIF分类,根据不同类型分别采用“T”钢板内固定、闭合复位外支架及闭合复位外支架克氏针联合固定术。结果35例经5～16个月随访,按照Dinest腕关节功能评估,总优良率84．2％,其中钢板内同定组15／17,单纯外支架组11／13,外支架联合克氏针组4／5。结论依据桡骨远端关节内不同类型骨折,分别采用相应手术固定方法,对恢复桡骨相对长度、掌倾度、尺偏角、关节面的平整以及腕关节的功能极为重要。     

Treatment of intra-articular distal radius fractures by external radio-radial fixation--two case studies]

The paper presents two cases of the intra-articular distal radius fractures treated with good results by external radio-radial fixation. Techniques of the method are discussed. The advantages of the method are good stability and early function of the wrist after treatment. The indication for this method is distal radius fractures typ A3, C2 and C3 according the AO classification.     

斜T形锁定加压接骨板治疗桡骨远端骨折的临床研究

目的 探讨应用锁定加压接骨板(locking-compression plate，LCP)治疗桡骨远端骨折的可行性及临床应用价值。方法 对按AO分类为B型和C型的桡骨远端骨折病人19例，按AO内固定原则并根据桡骨的解剖外形，使用纯钛斜T形LCP行内固定治疗。结果 术后随访6-10个月，采用腕关节功能及X线片测量指标进行综合评定，优17例、良2例，总优良率为100％。结论 采用斜T形LCP能够用于治疗B、C类型的桡骨远端骨折，术中副损伤少，血运破坏小。尤其对于不稳定的、难治性的骨质疏松性的桡骨远端骨折具有良好的治疗效果，能够牢固维持术中恢复的解剖形状，有利于患肢早期的功能锻炼。     

T形钢板内固定治疗桡骨远端不稳定骨折

目的探讨T型钢板内固定治疗桡骨远端骨折的临床疗效。方法对按AO分类为B、C型的28例桡骨远端骨折患者,按A0内固定原则,使用斜“T”形或“T”形钢板行内固定治疗。结果术后随访4～18个月,平均12个月,所有患者均获得骨性愈合,根据术后X线片及改良Shea功能评估标准,优21例,良5例,可2例,优良率为93％。结论“T”形钢板治疗桡骨远端骨折临床疗效满意,尤其对于不稳定型以及骨质疏松性桡骨远端骨折,能够牢固维持术中恢复的解剖形状,有利于患腕早期功能锻炼。     

肱骨远端关节内骨折的手术治疗

目的探讨肱骨远端关节内骨折手术治疗效果。方法14例肱骨远端关节内粉碎性骨折,按AO/ASIF分型,B型2例,C1型8例,C2型3例,C3型1例。采用钢板或克氏针、松质骨螺钉固定4例,“Y”形钢板内固定10例。结果14例均获得随访,随访时间9～20个月。按Aitken和Rorabeck标准进行功能评定:优9例,良3例,可2例。结论治疗肱骨远端关节内骨折应解剖复位、有效固定、早期功能锻炼,手术治疗是比较好的选择。     

桡骨远端关节内骨折外固定器治疗的相关机制和原则探讨

目的 分析和探讨桡骨远端关节内骨折外固定器治疗的相关机制和原则.方法 笔者采用Orthofix外固定器和国产组合式外固定器治疗桡骨远端关节内骨折45例46肢,以齐藤英彦法对资料完整的37例38肢病例进行分型,分析其影像学表现、损伤和治疗相关机制以及特点.结果 各型复位方向和外固定腕关节位置均与致伤暴力方向相反.骨折愈合时间平均为43 d(37～62 d),平均随访时间14个月(3～56个月),按Dienst标准评估腕关节功能及疗效:优21例22肢,良10例10肢,可6例6肢.结论 闭合复位外固定能很好地解决桡骨远端关节内骨折的治疗问题,特别适用于粉碎型关节内骨折.其治疗原则是复位方向及腕关节外固定位置与损伤机制、移位情形相反,个别骨折块辅以切开复位时须强调有限切开,必须重视部分病例伴有的同侧桡骨中远段骨折和同侧尺骨远段骨折的处理.     

The application of indirect reduction techniques in the distal radius: The role of adjuvant arthroscopy

Purpose: The re-establishment of distal radius alignment and articular congruency after fracture has been approached by a variety of methods in order to limit injury sequelae such as degenerative osteoarthritis. Although arthroscopy has been beneficial for other articular fractures, it is unclear to what degree arthroscopy should be used for treatment of distal radius articular fractures, especially when avoiding full-open procedures that can promote arthrofibrosis. The purpose of this study was to determine the utility of adjuvant wrist arthroscopy and whether a diagnostic benefit is observed during treatment. Type of Study: A modified protocol for treatment of intra-articular distal radius fractures was developed in a crossover trial fashion for the purposes of this study. Materials and Methods: Thirty-three consecutive subjects treated over a 2-year period were included for study. Fractures were classified according to Melone, treated by indirect reduction techniques under fluoroscopic visualization, stabilized by static external fixation, and supplemented with percutaneous pins or bone graft as needed. The adequacy of reduction under fluoroscopic visualization was assessed by arthroscopic visualization after this initial treatment. Results: 14.3% of type I fractures, 37.5% of type II fractures, 33.3% of type III fractures, and 71.4% of type IV fractures were modified due to arthroscopic visualization after initial treatment by indirect reduction techniques. No subject required a full-open procedure for subsequent reduction. Conclusions: Based on these data, surgical treatment of intra-articular distal radius fractures solely under fluoroscopic visualization appears inadequate to re-establish articular congruency. Adjuvant wrist arthroscopy provides a diagnostic benefit in determining whether distal radius articular fracture reduction is adequate and may also translate to direct improvement in patient satisfaction and outcome by limiting injury sequelae. When considering indirect reduction techniques for distal radius articular injury, we recommend routine arthroscopic evaluation to verify and assist in re-establishment of articular congruency.Arthroscopy: The Journal of Arthroscopic and Related surgery, Vol 16, No 8 (November-December), 2000: pp 830–835     

The application of indirect reduction techniques in the distal radius

Purpose: The re-establishment of distal radius alignment and articular congruency after fracture has been approached by a variety of methods in order to limit injury sequelae such as degenerative osteoarthritis. Although arthroscopy has been beneficial for other articular fractures, it is unclear to what degree arthroscopy should be used for treatment of distal radius articular fractures, especially when avoiding full-open procedures that can promote arthrofibrosis. The purpose of this study was to determine the utility of adjuvant wrist arthroscopy and whether a diagnostic benefit is observed during treatment. Type of Study: A modified protocol for treatment of intra-articular distal radius fractures was developed in a crossover trial fashion for the purposes of this study. Materials and Methods: Thirty-three consecutive subjects treated over a 2-year period were included for study. Fractures were classified according to Melone, treated by indirect reduction techniques under fluoroscopic visualization, stabilized by static external fixation, and supplemented with percutaneous pins or bone graft as needed. The adequacy of reduction under fluoroscopic visualization was assessed by arthroscopic visualization after this initial treatment. Results: 14.3% of type I fractures, 37.5% of type II fractures, 33.3% of type III fractures, and 71.4% of type IV fractures were modified due to arthroscopic visualization after initial treatment by indirect reduction techniques. No subject required a full-open procedure for subsequent reduction. Conclusions: Based on these data, surgical treatment of intra-articular distal radius fractures solely under fluoroscopic visualization appears inadequate to re-establish articular congruency. Adjuvant wrist arthroscopy provides a diagnostic benefit in determining whether distal radius articular fracture reduction is adequate and may also translate to direct improvement in patient satisfaction and outcome by limiting injury sequelae. When considering indirect reduction techniques for distal radius articular injury, we recommend routine arthroscopic evaluation to verify and assist in re-establishment of articular congruency.     

掌侧人路治疗背侧移位的桡骨远端关节内骨折

目的 应用掌侧入路治疗背侧移位的桡骨远端关节内骨折,评估蘑建桡腕关节面的完整性和稳定固定骨折的可靠性.方法 2003年8月至2008年5月,经掌侧入路治疗63例(65侧)背侧移位的桡骨远端关节内骨折,男20例(21侧),女43例(44侧);年龄18～82岁,平均年龄52.4岁,以老年居多.按照Frykman分类法,Ⅲ型骨折6侧,Ⅳ型骨折8侧,Ⅴ型骨折5侧,Ⅵ型骨折4侧,Ⅶ型骨折13侧,Ⅷ型骨折29侧.术中除采用桡腕关节造影术和标准的腕关节正侧位外,应用新的切线位的腕关节正侧位观察远端螺钉与关节面的关系.结果 53例(54侧)获得随访,随访时间5～47个月,平均16.4个月.按照Gartland和Werley评分,优32侧(59.3%),良14侧(25.9%),可7侧(13.O%),差1侧(1.8%),优良率85.2%.应用新的切线位的腕关节正侧位X线片显示42侧标准的腕关节正侧位的26侧正位和31侧侧位的远端螺钉进入关节.结论 掌侧入路的方法对于大多数不同类型的桡骨远端关节内骨折是一种简单有效的治疗方法.     

External fixation in comminuted,displaced intra-articular fractures of the distal radius: is it sufficient?

Introduction: External fixation has been extensively used to treat the intra-articular fractures of the distal radius and it has several distinct advantages over conventional POP cast and plate fixation. However, the limitation of external fixation to achieve articular congruity in the comminuted intra-articular fractures of the distal radius has been documented in the literature. This could be because external fixation alone does not expand crushed cancellous bone and cannot work without soft tissue hinges. This prospective study was conducted to look at the results of comminuted, displaced intra-articular fractures of the distal radius treated exclusively by external fixation. Materials and methods: A 2-year follow-up of 27 patients with comminuted, displaced intra-articular fractures of distal radius that were treated exclusively by external fixation is presented. The radiological results, functional results and complications were analyzed according to the scoring system given by Jakim et al. Results: Anatomical reduction could not be achieved in 12 patients (44%) and reduction was lost in two patients (7%). Excellent and good results were seen in 59.3%, fair results were seen in 22.2% and poor results were seen in 18.5% of the cases. Outcome scores of patients without articular step were significantly better as compared to the patients with articular step at healing. There was a positive correlation between the restoration of normal anatomy (radiological results) and the functional outcome (r=0.775). Overall nine patients (33%) had complications. Conclusion: We conclude that although the external fixation is reliable in maintaining the reduction in displaced comminuted intra-articular fractures, it is inadequate in restoring articular congruity in many cases. The complications of external fixation are frequent and may be potentially serious in nature.