桡骨远端背侧钢板内固定治疗桡骨远端背侧不稳定骨折

目的探讨经背侧入路桡骨远端背侧钢板内固定治疗桡骨远端背侧不稳定骨折的临床疗效。方法回顾性分析自2016-01—2018-12诊治的22例桡骨远端背侧不稳定骨折,采用背侧入路置入桡骨远端背侧钢板,骨质缺损明显者行异体骨移植。结果 22例均获得随访,随访时间平均18(10~26)个月。22例均骨性愈合,愈合时间平均10(8~12)周。术后X线片显示桡骨短缩平均1.7(0~3)mm,掌倾角平均10°(7°~13°),尺偏角平均20°(14°~25°)。术后腕关节活动范围:背伸41°~58°,平均54°;掌屈43°~56°,平均50°;桡偏16°~31°,平均25°;尺偏21°~35°,平均29°;前臂旋前62°~80°,平均74°;前臂旋后54°~85°,平均71°。末次随访时腕关节功能Gartland-Werley评分:优16例,良4例,可2例。结论背侧入路桡骨远端背侧钢板内固定治疗复杂桡骨远端背侧骨折是行之有效的方法,但术前需准确判断骨折类型,术中需精细分离软组织并尽可能使复杂骨折简单化,同时术后循序渐进完成功能锻炼也十分重要。     

背侧入路解剖钢板内固定治疗桡骨远端C型骨折

目的探讨背侧入路解剖钢板内固定治疗桡骨远端C型骨折的临床疗效。方法采用背侧入路解剖钢板内固定治疗桡骨远端C型骨折20例。结果术后随访8~24个月,采用腕关节功能及X线片测量指标进行评定:优15例,良5例,优良率为100%。结论采用背侧入路解剖钢板内固定治疗桡骨远端C型骨折具有良好的手术效果。     

背侧入路解剖钢板内固定治疗桡骨远端C型骨折

目的探讨背侧入路解剖钢板内固定治疗桡骨远端C型骨折的临床疗效。方法采用背侧入路解剖钢板内固定治疗桡骨远端C型骨折20例。结果术后随访8-24个月，采用腕关节功能及X线片测量指标进行评定：优15例，良5例，优良率为100％。结论采用背侧入路解剖钢板内固定治疗桡骨远端C型骨折具有良好的手术效果。     

桡骨远端背侧粉碎骨折的T形钢板治疗

目的探讨切开复位背侧T形钢板内固定治疗背侧粉碎的桡骨远端骨折的疗效。方法对23例手法复位失败的背侧粉碎桡骨远端骨折行切开复位、T形钢板内固定,并随访其骨折愈合情况及远期功能效果。结果所有病例均获随访,平均随访时间为8．2个月（6～13个月）。所有骨折均获骨性愈合,愈合时间为52d（49～56d）,无伤口感染、骨不连、内固定断裂脱出、伸指受限等并发症。根据Colles骨折的改良Green and O’Brien临床评定标准综合评定,优17例,良6例。结论对于手法复位失败的背侧粉碎桡骨远端骨折,切开复位、背侧T形钢板内固定能获得满意的治疗效果。     

掌侧锁定钢板联合背侧入路植骨治疗桡骨远端背侧不稳定性骨折

[目的]探讨掌侧锁定钢板联合背侧入路植骨在治疗桡骨远端背侧不稳定性骨折的应用及临床疗效。[方法]总结2005年8月~2010年1月经掌侧入路锁定钢板联合背侧入路植骨治疗桡骨远端背侧不稳定性骨折27例。男8例,女19例,年龄55.6岁(50~65岁),按AO分类:A3型12例,C2型10例,C3型5例,均为闭合性骨折。所有病例均采取掌侧入路,局限性显露背侧骨折端并行骨诱导活性材料(金世植骨灵)镶嵌支撑植骨。术后均予以石膏托外固定2周。[结果]27例全部获得随访,随访时间平均17.5个月(12~24个月)。X线片显示骨折全部I期愈合,平均愈合时间为8周。术后1年X线片测量:桡骨茎突短缩均≤2 mm;掌倾角10.5°(5°~17°);尺偏角19.5°(15°~26°);关节面塌陷、移位矫正均≤2 mm;1例显示关节间隙变窄。术后功能康复时间8~30周,平均20.5周。术后患侧腕关节运动范围为:掌屈60°(30°~70°);背伸55°(30°~65°);桡偏:17°(10°~20°);尺偏25.5°(20°~30°);前臂旋前65.5°(60°~70°);旋后75.5°(60°~80°)。握力测量平均为健侧的65%(...     

掌侧锁定钢板联合背侧植骨治疗C3型桡骨远端骨折的疗效观察

目的 观察掌侧锁定钢板联合背侧植骨治疗C3型桡骨远端骨折的疗效。方法 回顾性分析我院2016年1月至2017年12月收治的采用掌侧锁定钢板内固定联合背侧入路植骨的19例桡骨远端AO C3型骨折病人,术后测量桡骨远端掌倾角、尺偏角及桡骨高度,采用Gartland和Werley评分系统评估腕关节功能。结果 所有病人均获得1年以上随访,Gartland和Werley腕关节功能评分显示：优10例,良7例,可2例。末次随访掌倾角为9.48°±1.84°、尺偏角为14.68°±0.82°及桡骨远端高度为（12.45±0.32） mm,与术前比较,差异均有统计学意义（P均＜0.05）。未出现伤口感染、肌腱激惹、肌腱断裂及创伤性关节炎等并发症。结论 掌侧锁定钢板联合背侧植骨治疗桡骨远端AO C3型骨折简单、可靠且有效。     

桡骨远端骨折致月骨损伤的MRI表现

目的通过分析桡骨远端骨折合并腕骨损伤的MRI表现,证明桡骨撞击可以导致月骨损伤。方法自1997年3月至6月收治急症初诊桡骨远端骨折患者46例,男16,女30例;年龄28～62岁,平均48.2岁。确诊后均采取保守治疗,复位纠正阳性尺骨变异,尺骨变异范围要求达到1.5mm以内。骨折按MayoClinic分型：Ⅰ型18例（39%）、Ⅱ型14例（30%）、Ⅲ型9例（20%）、Ⅳ型5例（11%）。拍摄腕部正位及侧位X线片,用投影线技术测量尺骨变异。行CT检查排除月骨和三角骨微骨折、囊性变和先天发育不良。行MR检查观察月骨损伤和损伤信号出现的位置。结果MRI出现月骨损伤信号42例（91%）,Ⅰ型15例（15/18,83%）、Ⅱ型13例（13/14,93%）、Ⅲ型9例（9/9,100%）、Ⅳ型5例（5/5,100%）。损伤信号单纯位于月骨尺侧近端35例（占月骨损伤信号的83%）,单纯位于月骨中部5例（12%）,月骨中部和尺侧近端同时出现损伤信号2例（5%）。月骨中部出现损伤信号的7例患者中5例为MayoClinicⅢ型桡骨远端骨折,MayoClinic骨折类型与月骨中部损伤信号的出现率有相关性（Χ^2=19.475,P=0.000,r=0.545）。三角骨中心出现损伤信号2例,与月骨相关节的桡骨区出现不同程度的损伤信号。结论桡骨远端骨折导致的月骨损伤,其MRI上月骨损伤信号位于不同部位,从力学角度分析月骨中部的损伤信号应为桡骨撞击所致。     

掌侧锁定接骨板结合背侧支撑钢板固定治疗不稳定的背侧移位桡骨远端骨折

[目的]初步探讨掌侧锁定加压钢板(locking compression plate,LCP)结合背侧支撑钢板固定治疗不稳定、背侧移位桡骨远端骨折的方法及其效果。[方法]回顾性分析掌侧LCP结合背侧1/4管型钢板固定治疗不稳定、背侧移位桡骨远端骨折23例,比较手术前后掌倾角、尺偏角、桡骨短缩及关节活动范围等,初步评价其临床疗效。[结果]经随访13~24个月(平均15个月),掌倾角、尺偏角、桡骨短缩均获明显改善,腕关节功能按Sarmiento标准评定,优18例、良5例。[结论]对不稳定、背侧移位桡骨远端骨折,掌侧LCP结合背侧支撑钢板固定是一种安全有效的治疗方法,可有效防止复位丢失,获得较为满意的腕关节功能。     

非角度稳定性钢板固定治疗桡骨远端关节内背侧移位骨折的结果

Objective Intra-articular fractures of the distal radius in young adults comprise a distinet fracture pattern that is diffficuh to manage and associated with a high frequency of post-traumatic arthritis.Restoration of articular congruency and alignment should improve the outcome.Methods In this study we prospectively re- viewed the results of 21 consecutive cases of dorsally displaced intra-articular distal radius fractures which were treated with internal fixation after failing to achieve articular congruency with closed reduction.Results 3 patients were lost to follow-up.For the rest of 18 patients,follow-up time ranges from 18 to 75 weeks the fractures had healed with highly satisfactory radiographic and functional results.The final volar tilt averaged 4.9°;radial inclination 23.9°;radial length 14mm;and articular incongruity,0.1 mm.Wrist motion at final follow-up examination aver- aged flexion 62°,extension 60°,radial deviation 16°,ulnar deviation 27°,pronation 77°and supination 74°.Grip strength averaged 83% of the uninjured side.The overall outcome of 18 patients(94.4%)had a good or excellent result according to the system of Gartland and Werley and 18 patients(72.2%)had a good result according to the modified system of Green and O'Brien at the most recent evaluation.The only complication in this series was a superficial pin tract infection,which was rapidly resolved with removal of pins at 5th week of external fixation. Conclusion Thus restoration of articular congruency and alignment is possible with minimal complication using modern non-angular stable methods of internal fixation.     

桡骨远端骨折合并月骨脱位的治疗

目的 探讨桡骨远端骨折伴月骨脱位的治疗方法.方法 2001年1月-2006年6月,对28例桡骨远端骨折伴月骨脱位的患者,其中新鲜损伤16例,采用手法复位石膏固定6例,微创撬拨复位、克氏针加石膏固定10例.陈旧性损伤12例,采用保守治疗后月骨再脱位3例,月骨漏诊9例;其中4例行掌侧入路月骨复位术,克氏针加石膏固定,8例行背侧入路月骨复位术,修复桡月背侧韧带,克氏针加石膏固定.腕关节功能按Lidstrom评分标准评定及腕部X线片检测有无月骨坏死.结果 术后28例获得随访时间为1～4年(平均2.2年),腕关节功能评分:新鲜损伤组优良率为93.8%,陈旧性损伤组优良率为75.0%.腕部X线片显示:新鲜损伤组月骨坏死率为0,陈旧损伤组月骨坏死率为25.0%.陈旧性损伤组掌侧切口入路月骨坏死率为50.0%,背侧入路月骨坏死率为12.5%.结论 桡骨远端骨折伴月骨脱位的治疗关键在于及时诊断和处理月骨脱位,避免发生陈旧性月骨脱位,后者手术以背侧入路复位固定并同时修复桡月背侧韧带为宜.     

掌侧T形钢板治疗桡骨远端不稳定骨折

目的评价掌侧T形钢板治疗桡骨远端不稳定骨折的疗效。方法采用掌侧T形钢板治疗桡骨远端不稳定骨折患者80例,AO分型A3型20例,B1型2例,B2型1例,B3型1例,C1型21例,C2型22例,C3型13例。结果本组80例患者全部获得随访,随访6～38个月(平均25.3个月),骨折全部愈合。采用Dienst腕关节功能标准评价疗效:优67例,良9例,可4例。结论掌侧T形钢板治疗桡骨骨远端不稳定骨折,内固定牢靠,可早期进行功能锻炼,疗效满意。     

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

桡骨远端骨折是一种常见的骨折,其发生率约占急诊骨折的17%[1]。大多数病例通过传统的闭合复位石膏或夹板外固定治疗能够取得良好的疗效,但对于不稳定桡骨远端骨折,尤其是关节内骨折,手法复位困难,复位后丢失率高,容易遗留肢体短缩、关节畸形、活动受限及创伤性关节炎等后遗症。随着对桡骨远端骨折的认识不断深化,对于桡骨远端不稳定骨折越来越倾向于手术治疗。我院自2001-2004年使用T形钢板内固定治疗桡骨远端不稳定骨折18例,疗效满意。1临床资料本组18例,男10例,女8例;年龄23~68岁,平均45岁;左侧7例,右侧11例。根据AO分类:B3型5例,C1型8…     

有限内固定结合石膏外固定治疗桡骨远端粉碎性骨折

1996年8月—2000年12月，我院采用有限内固定结合石膏外固定治疗桡骨远端粉碎性骨折36例，经随访观察，效果满意，现总结报告如下。     

单轴与多轴锁定接骨板治疗桡骨远端骨折的疗效比较

背景:切开复位锁定接骨板内固定是桡骨远端骨折的常用治疗方法。根据锁定方式的不同,锁定接骨板分为单轴与多轴两类,二者各有其特点。目的:比较单轴掌侧锁定接骨板(MA-VLP)与多轴掌侧锁定接骨板(PA-VLP)内固定治疗桡骨远端骨折的疗效。方法:回顾分析2014年1月至2018年6月接受手术治疗的77例桡骨远端骨折患者资料。采用MA-VLP固定37例(MA组),PA-VLP固定40例(PA组)。记录手术时间、骨折愈合时间、并发症,测量术后影像学参数,采用DASH评分和Mayo评分评估患肢功能。结果:两组患者均获得良好骨折复位、稳定内固定及骨折愈合。PA组手术时间显著短于MA组(P<0.05)。两组均未出现伤口深部感染、骨折不愈合或畸形愈合、内固定失效等并发症。两组患者骨折愈合时间、术后并发症、影像学参数比较,差异均无统计学意义(P>0.05)。术后6周、12周,PA组DASH评分显著低于MA组(P<0.05);术后6个月及末次随访,两组DASH及Mayo评分差异均无统计学意义(P>0.05)。结论:MA-VLP与PA-VLP内固定用于桡骨远端骨折,均可获得满意的临床疗效,但后者手术时间更短,更利于早期功能恢复。     

A new volar plate made of carbon-fiber-reinforced polyetheretherketon for distal radius fracture: analysis of 40 cases

Background

Implants based on the polyetheretherketon (PEEK) polymer have been developed in the last decade as an alternative to conventional metallic devices. PEEK devices may provide several advantages over the use of conventional orthopedic materials, including the lack of metal allergies, radiolucency, low artifacts on magnetic resonance imaging scans and the possibility of tailoring mechanical properties. The purpose of this study was to evaluate the clinical results at 12-month follow-up using a new plate made of carbon-fiber-reinforced polyetheretherketon for the treatment of distal radius fractures.

Materials and methods

We included 40 consecutive fractures of AO types B and C that remained displaced after an initial attempt at reduction. The fractures were classified according to the AO classification: 21 fractures were type C1, 9 were type C2, 2 were type C3, 2 were type B1 and 6 were type B2.

Results

At a 12-month follow-up no cases of hardware breakage or loss of the surgically achieved fracture reduction were documented. All fractures healed, and radiographic union was observed at an average of 6 weeks. The final Disabilities of Arm, Shoulder and Hand score was 6.0 points. The average grip strength, expressed as a percentage of the contralateral limb, was 92 %. Hardware removal was performed only in one case, for the occurrence of extensor tenosynovitis.

Conclusion

At early follow-up this device showed good clinical results and allowed maintenance of reduction in complex, AO fractures.

Type of study/level of evidence

Therapeutic IV.     

新型锁定加压钢板治疗老年桡骨远端C型骨折

目的 探讨新型2.4 mm锁定加压钢板(LCP)治疗老年桡骨远端C型骨折的初期疗效.方法 回顾性分析2006年10月至2008年11月采用新型2.4 mm LCP治疗21例老年桡骨远端C型骨折患者,男7例,女14例;年龄71～85岁,平均76岁.骨折按AO分型:C1型6例,C2型13例,C3型2例,均为闭合性骨折.所有患者均经掌侧入路复位固定,术中不显露背侧组织,骨缺损严重行置入人工骨.结果 所有患者获平均10.6个月(8～27个月)随访.X线片示骨折全部一期愈合,平均愈合时间为8周.2例骨缺损严重者,术中植入人工骨.所有患者均无感染、骨不连、钢板松动、腕管综合征等并发症发生.术后功能康复时间4～36周,平均11周.腕关节活动度:背伸23°～84°,平均71.3°;掌屈33°～86°,平均72.0°;尺偏19°～29°,平均26.3°;桡偏12°～30°,平均19.9°;前臂旋前60°～87°,平均79.5°;旋后52°～80°,平均76.4°.与健侧对比,握力减弱3例,活动后疼痛3例.按改良的Mcbride腕关节功能评价标准:优14例,良5例,可2例,优良率为90.5%.结论 新型2.4 mm LCP治疗老年骨质疏松引起的桡骨远端C型骨折,内固定坚强,可以早期功能锻炼,疗效佳.     

背侧双板固定治疗桡骨远端粉碎性骨折

目的 探讨采用背侧入路复位、双板固定治疗桡骨远端粉碎性骨折的手术指征及疗效.方法 采用背侧人路行骨折复位、植骨、双板固定治疗C型桡骨远端粉碎性骨折10例,其中男2例,女8例;患者平均年龄72岁.结果 术后随访时间6～26个月,平均14个月,按照改良的Garland-Werley评分标准评定:平均为2分(0～12分),其中优5例、良4例、可1例.结论 背侧双板固定治疗桡骨远端粉碎性骨折手术操作难度较高,但是背侧复位、植骨、固定更符合局部的解剖学特点和骨折的受伤机制,是治疗桡骨远端粉碎性骨折的有效方法之一.

Abstract：

Objective To discuss the indications, methods and treatment outcomes of double plate internal fixation of comminuted distal radius fractures via a dorsal approach. Methods Ten patients of type C comminuted distal radius fractures were treated by dorsal approach reduction, bone graft and double plate internal fixation. Among them, 2 were male and 8 were female. The average age of the patients was 72 years. Results Postoperatively the patients were followed up for 6 to 26 month, with an average of 14 months. The mean Garland and Werley score was 2 (range 0 to 12). Results were considered excellent in 5 cases, good in 4 cases and fair in 1 case. Conclusion Dorsal double plate fixation for comminuted distal radius fracture is technically challenging. However dorsal reduction, bone grafting and fixation is more in line with the anatomy of distal radius and the injury mechanism. It is one of the most effective methods for treating this type of complex fractures.     

Volar plate versus k-wire fixation of distal radius fractures

The optimal management of distal radius fractures remains controversial. The aim of this study was to compare the radiographic and functional outcomes of 318 patients who underwent k-wire fixation or volar plating for fractures of the distal radius. Patients were aged between 20 and 65 years and followed for a mean of 32 months. The mean values for volar tilt, radial inclination, radial length and ulnar variance were all significantly better in the volar plate group. Malunion occurred in 13.2% of patients undergoing k-wiring and 4% of patients treated with a volar plate (p < 0.007). Higher values for radial inclination, radial length and volar tilt correlated with better functional outcome as measured by disabilities of the arm shoulder and hand (DASH) and patient rated wrist evaluation (PRWE) scores. Lower values for ulnar variance correlated with better functional outcome. Although volar plate treatment resulted in a superior radiological outcome, there was no evidence that this translated into a superior functional outcome (DASH 13.12 vs. 11.25, p = 0.28) (PRWE 17.56 vs. 16.31, p = 0.69). The k-wiring procedure remains a suitable inexpensive option for simple fractures. Volar plating should be reserved for complex fractures that cannot be reduced by closed means.