选择性非手术治疗不稳定性桡骨远端骨折的临床研究

目的 探讨选择性非手术治疗不稳定性桡骨远端骨折临床效果.方法 采用手法复位背侧单夹板掌屈10～20°位固定治疗背侧倾斜、塌陷且向掌侧成角的桡骨远端新鲜闭合性骨折20例,并在C型臂X线机监视下对整复后腕关节固定位置进行观测.结果 本组20例在腕关节中立位固定时有移位的可能,占45%(9/20);在掌屈位周定均未发生骨折端...     

桡骨远端骨折的治疗

桡骨远端骨折的治疗方式多样。Ｌｅｎｏｂｌｅ以９６例桡骨远端骨折，比较了克氏针经桡骨突固定或Ｋａｐａｎｄｊｉ方法的疗效，发现其最科呈一致性。经桡骨芭 固定能更好地控制桡骨短缩，Ｋａｐａｎｄｊｉ方法引起桡神经损伤和ＲＳＤ更多。ＭｃＢｉｒｎｅｉ早期切开复位加植骨的方法，可得到良好的解剖复位，无需外固定支架，而功能结果及并发症与其它治疗技术类似。     

可调式外固定架治疗桡骨远端骨折的临床研究

可调式外固定架是我院研制改进的治疗桡骨远端骨折的外固定器(浙药管械(准)字2001第21000231号)。我院从1998—2003年用可调式外固定架治疗桡骨远端骨折64例，取得了满意效果，现报告如下。     

桡骨远端骨折与腕关节不稳的临床研究

目的研究桡骨远端骨折保守和手术治疗后腕关节不稳的转归及关节不稳对功能的影响。方法1999年1月～2004年3月,临床随访124例采用石膏、外固定支架和桡骨远端钢板固定治疗的桡骨远端骨折患者,根据X线片测量判断治疗前、后腕关节不稳的变化,Gartland与Werley评分标准评定腕关节功能恢复情况。结果随访中发现有背侧偏移、掌侧偏移、背屈不稳(DISI)、掌屈不稳(VISI)和舟月分离五种腕关节不稳;治疗前、后和随访时腕关节不稳发生率分别为58.1%、21.8%和22.6%;优良率为80.6%,稳定组和不稳定组优良率分别为84.5%和75.0%。结论桡骨远端骨折后常可合并不同类型的腕关节不稳,手术治疗可以有效纠正桡腕关节不稳,舟月分离性腕关节不稳很难被纠正,腕关节不稳定组的腕关节功能明显比腕关节稳定组差,桡腕关节的完整性是影响腕关节功能的主要因素。     

桡骨远端骨折分型新论

桡骨远端骨折的分型国内外学者早有论述。1814年英国人克雷氏曾系统报道桡骨远端伸直型骨折,间接暴力引起,骨折远端向背侧桡侧移位,向掌侧成角。以后史密斯又报道桡骨远端屈曲型骨折。再后又报道背侧缘劈裂型骨折,又称巴尔通骨折和掌侧缘劈裂骨折,又称反巴尔通骨折。笔者在临床     

功能性外固定器治疗桡骨远端骨折的生物力学测试及临床研究

目的 进行功能性外固定器治疗桡骨远端骨折的生物力学测试，为临床提供可靠的科学依据。方法 采用12具新鲜尸体桡骨标本对其骨折固定后在扭转、弯曲、拉压的生物力学性能进行实验分析，并应用临床41例。结果 弯曲、扭转试验在1．2Nm～4．8Nm力的作用下其变化微小，拉压试验10N～40N力作用下其变化不大，在试验中未见固定折端处钢针拔出及外固定器损坏，并通过对41例患者4个月～15个月的随访，骨折端复位优良率达93％，腕关节功能优良率98％。结论 该外固定器操作简单，固定可靠，创伤小，并发症少，符合桡骨远端的生物力学需要，使骨折复位与固定，愈合与功能恢复同步进行，可作为治疗桡骨远端不稳定性骨折较理想方法之一。     

LCP治疗桡骨远端不稳定性骨折

目的：探讨桡骨远端不稳定性骨折掌侧锁定加压接骨板（locking compress plate, LCP）治疗效果。方法对2008年10月—2012年12月收治的48例桡骨远端不稳定性骨折患者,采取掌侧切口锁定加压接骨板固定。结果本组48例均获得术后随访,时间4～18个月（平均13个月）。按Dienest标准评价疗效：优40例,良6例,差2例,优良率96%。结论桡骨远端不稳定性骨折实行切开复位LCP内固定,术后骨折固定稳定,恢复效果满意。     

桡骨远端骨折与腕关节不稳的临床研究

桡骨远端骨折是临床上最常见的骨折之一．研究发现骨折后常可合并腕关节不稳。然而。在治疗中往往被临床医生所忽略．导致不同程度的腕关节功能障碍。现对124例采用不同方法治疗的桡骨远端骨折作临床随访．研究腕关节不稳于不同治疗前后的变化．以及对腕关节功能的影响。     

功能性外固定器治疗桡骨远端骨折的生物力学测试及临床研究

目的　进行功能性外固定器治疗桡骨远端骨折的生物力学测试 ,为临床提供可靠的科学依据。方法　采用 1 2具新鲜尸体桡骨标本对其骨折固定后在扭转、弯曲、拉压的生物力学性能进行实验分析 ,并应用临床 4 1例。结果　弯曲、扭转试验在1 2Nm～ 4 8Nm力的作用下其变化微小 ,拉压试验 1 0N～ 4 0N力作用下其变化不大 ,在试验中未见固定折端处钢针拔出及外固定器损坏 ,并通过对 4 1例患者 4个月～ 1 5个月的随访 ,骨折端复位优良率达 93% ,腕关节功能优良率 98%。结论　该外固定器操作简单 ,固定可靠 ,创伤小 ,并发症少 ,符合桡骨远端的生物力学需要 ,使骨折复位与固定 ,愈合与功能恢复同步进行 ,可作为治疗桡骨远端不稳定性骨折较理想方法之一。     

桡骨远端骨折的治疗

近年来,对于桡骨远端骨折的治疗观念不断更新,针对各种类型的桡骨远端骨折出现了不同的治疗方法,治疗手段不断完善。本文对桡骨远端的解剖、分类方法、治疗方法(包括闭合复位外固定、经皮穿针术、外固定架技术、切开复位内固定术、腕关节镜技术以及植骨技术的应用等)进行了综述。并对当前的治疗方法提出了几点看法:A型(AO分型)骨折首选闭合复位石膏外固定;对B型和C1型骨折在手法复位不满意的情况下首选切开复位斜T形钛板内固定;对C2和C3型骨折首选切开复位斜T形钛板内固定,干骺端粉碎无法进行钛板内固定时,采用切开复位外固定架固定术,并视术中情况决定是否使用克氏针内固定;对骨质疏松的老年患者采用LCP内固定,具体视骨折的骨缺损情况及骨质情况决定是否进行骨移植。     

Ulnar styloid process nonunion and outcome in patients with a distal radius fracture: A meta-analysis of comparative clinical trials

PurposeThere is no consensus on the relation between ulnar styloid process nonunion and outcome in patients with distal radius fractures. The aim of this study was to analyze whether patient-reported outcome is influenced by the nonunion of the accompanying ulnar styloid fracture in distal radius fracture patients.MethodsA meta-analysis of published studies comparing outcomes after distal radius fractures with a united versus a non-united ulnar styloid process was performed. In addition, if provided by the authors, the raw data of these studies were pooled and analysed as one study. The outcome measures of the analyses included patient-reported outcome, functional outcome, grip-strength, pain, and distal radioulnar joint (DRUJ) instability.ResultsData from six comparative studies were included, concerning 365 patients with a distal radius fracture. One hundred and thirty-five patients with an ulnar styloid union were compared with 230 patients with a nonunion of the ulnar styloid. No significant differences were found between groups regarding any outcome measure.ConclusionBased on this meta-analysis, there is no relation between the nonunion of the ulnar styloid process and function in patients with a distal radius fracture.     

老年桡骨远端骨折保守治疗的疗效分析

目的：研究桡骨远端骨折原始移位程度与骨折愈合后骨折对位质量的关系。方法：桡骨远端骨折患者41例，男5例，女36例；年龄50—82岁。平均67．8岁。按Lidstrom分型：Ⅰ型3例，Ⅱ型12例，Ⅲ型11例，Ⅳ型15例。按Frykman分型：Ⅰ型3例。Ⅱ型6例，Ⅲ型5例，Ⅳ型6例，Ⅴ型7型，Ⅵ型4例，Ⅶ型4例，Ⅷ型6例。粉碎性骨折加例。对愈合后的复位质量进行评估，并分别对LidstromⅠ-Ⅱ型和Ⅲ-Ⅳ型，FrykmanⅠ-Ⅳ型和Ⅴ-Ⅷ型，非粉碎性骨折和粉碎性骨折愈合后的复位质量进行了比较。结果：41例患者随访6个月，按Dienst复位质量评分，优3例，良21例，优良率为58．5％（24／41）。LidstromⅠ-Ⅱ型和Ⅲ-Ⅳ型愈合后复位质量优良率分别为86．7％（13／15）和42．3％（11／26）（P〈0．01）；FrykmanⅠ-Ⅳ型和Ⅴ-Ⅷ型愈合后复位质量优良率分别为65.0％（13／20）和52．4％（11／21）（P〈0.05）；非粉碎性骨折和粉碎性骨折愈合后复位质量优良率分别为81．0％（17／21）和35．0％（7／20）（P〈0．01）。结论：原始移位大的、粉碎性的不稳定桡骨远端骨折，愈合后容易出现短缩和再移位，建议采用经皮穿针、外固定支架及开放复位内固定等方法恢复并维持桡骨远端的解剖对应关系。     

微创经皮掌侧植入锁定钢板治疗桡骨远端骨折效果观察

目的观察微创经皮掌侧植入锁定钢板治疗桡骨远端骨折的效果。方法选取天津市津南医院2017-01-2018-12间收治的82例桡骨远端骨折患者,随机分为2组,各41例。对照组应用外固定支架治疗,观察组使用微创经皮掌侧植入锁定钢板治疗。比较2组的疗效。结果 2组切口长度、手术时间、术中出血量及术后尺偏角、桡骨高度、VAS评分差异无统计学意义(P>0.05)。观察组术后掌倾角显著高于对照组,术后3个月的腕关节主动活动度、相对健侧握力、Mayo评分显著高于对照组,差异有统计学意义(P<0.05)。术后1 a,2组腕关节活动度、相对健侧握力及Mayo评分差异无统计学意义(P>0.05)。结论微创经皮掌侧植入锁定钢板治疗桡骨远端骨折的远期疗效与外固定支架疗效相当,但其更利于术后患者腕关节功能的早期恢复。     

Long-term outcome of nonsurgically treated distal radius fractures

PURPOSE: To study the long-term outcome after nonsurgically treated distal radius fractures including recovery of grip strength, mobility, and radiographic parameters. METHODS: Eighty-seven patients, mean age 55 (range 19-78) years, treated with closed reduction and casts, were evaluated radiographically and clinically during the first 6 months and finally after 9-13 years. Fifty patients had extra-articular fractures (AO Class A), 4 had simple intra-articular fractures (AO Class B) and 33 had complete intra-articular fractures (AO Class C). RESULTS: Fifty-two of 66 patients with unilateral fractures were, after 9-13 years, rated as excellent/good according to the Green and O'Brien score as modified by Cooney et al (GOBC score). Fracture class according to AO did not correlate to outcome. Considerable fracture displacements remained: dorsal angulation (mean 13 degrees in <60 y, 18 degrees in >/=60 y), greater radial shortening than initially (mean 2 mm in <60 y, 3 mm in >/=60 y). Five patients had remaining joint step-off (1-2 mm) after reduction, but only one developed mild osteoarthritis. Patients with an unsatisfactory outcome had sustained more displaced fractures that also healed with greater displacement. The remaining subjective complaints were pain or reduced function during heavier tasks. Outcome was not correlated to age. Wrist mobility returned notably faster than grip strength. Patients over 60 years of age recovered slower in both mobility and strength. Closed reduction and plaster improved dorsal angulation but not radial shortening. CONCLUSIONS: Our data indicate that a number of patients with nonsurgically treated distal radius fractures still experience some hand/wrist impairment a decade after the trauma. The severity of fracture displacement seems to influence the clinical outcome in contrast to patients' age. Recovery of grip strength is slower than that of range of motion. Elderly patients recover more slowly than young patients. Dorsal angulation was improved but remained considerable (13 degrees -18 degrees ), while final radial shortening (2-3 mm) increased from the injury status.     

Effects of surgical and nonoperative treatment on wrist function of patients with distal radius fracture distal radius fracture

Purpose

To study the effects of surgical and nonoperative treatment on wrist function in patients with distal radius fracture.

桡骨远端骨折影像学测量指标与近期疗效的关系

目的 通过对桡骨远端骨折患者的影像学测量,分析各影像学参数和近期疗效之间的关系.方法 对62例桡骨远端骨折闭合复位石膏外固定的患者,利用StarPACS影像系统进行测量,并记录所有患者X线片的桡骨高、掌倾角及尺偏角的情况,并分析影像学测量指标与自测腕关节功能之间的关系.结果 62例桡骨远端骨折中,有50例(占80.6%)经保守治疗后效果优良.当桡骨高大于6.0 mm,掌倾角大于5°,尺偏角大于18°时,自测腕关节功能优良率较高.影像学指标和自测腕关节功能的相关性桡骨高＞掌倾角＞尺偏角.结论 桡骨高、掌倾角及尺偏角等可以作为桡骨远端骨折治疗效果评估的影像学指标,手法复位后影像学不达标者应当重新复位或采用手术治疗,桡骨远端骨折时应当首先考虑桡骨高的恢复.     

The evolution of distal radius fracture management: a historical treatise

Distal radius fractures (DRFs) have been a common affliction for millennia, but their treatment is a more recent development resulting from human erudition. Although immobilization has served as the only available treatment for most of our history, many advances have been made in the management of DRFs over the last century as orthopedics has grown. Yet the topic remains hotly contested in the literature and, given the frequency of the injury, research continues to focus on it. This article traces the evolution of DRF treatment to provide a context for the future.     

尺骨短缩术联合腕关节镜治疗桡骨远端骨折后畸形愈合的疗效分析

目的 探讨采用腕关节镜技术联合尺骨短缩术治疗桡骨远端骨折后畸形愈合的临床效果.方法 2013年9月至2015年9月我院收治桡骨远端骨折后畸形愈合病人67例,根据手术方法分为三组:联合治疗组,35例,采用腕关节镜技术联合尺骨短缩术治疗;尺骨短缩组,21例,采用单一的尺骨短缩术进行治疗;腕关节镜组,11例,采用单一的腕关节镜技术清理关节腔治疗.比较各组治疗后的数字评价量表(numerical rating scale,NRS)疼痛评分和上肢、肩、手功能障碍(disabilities of the arm,shoulder and hand,DASH)腕关节评分.结果 联合治疗组、尺骨短缩组治疗后的NRS疼痛评分分别为(1.32±0.52)分、(1.63±0.71)分,两组的腕关节DASH评分分别为(15.42±6.31)分、(18.03±7.64)分,均较术前明显改善,差异有统计学意义(P均<0.05);但腕关节镜组治疗后改善不明显.联合治疗组治疗后的NRS疼痛评分最低,腕关节镜组最高,三组间得分进行两两比较,差异均有统计学意义(均P<0.05).联合治疗组、尺骨短缩组治疗后的腕关节DASH评分差异并无统计学意义,但均优于腕关节镜组,差异均有统计学意义(均P<0.05).结论 尺骨短缩术联合腕关节镜技术对于桡骨远端骨折后畸形愈合造成的疼痛及功能障碍的改善具有积极的临床意义.     

A randomised clinical trial of activity-focussed physiotherapy on patients with distal radius fractures

Introduction: Physiotherapy is considered by some authorities to be an important aspect of management in patients following distal radius fractures. There is evidence of improvement in impairment with physiotherapy; however, there is no evidence to support early return of functional activity. Traditional physiotherapy management has focussed on improving impairment; however, there are no trials with emphasis on skill acquisition via motor re-learning principles. Materials and methods: Forty-one participants with conservatively managed distal radius fractures were studied in a randomised, single-blinded, prospective trial. Two treatment options were compared: exercise and advice versus activity-focussed physiotherapy with measurement periods of 6 weeks after removal of cast and follow-up at 24 weeks. Results: Participants allocated to the exercise and advice group consulted a physiotherapist an average of 0.9 (SD 0.4) times, while the participants allocated to the more intensive activity-focussed group consulted with physiotherapy a mean of 4.4 (SD 2.3) times. At both 6 and 24 weeks there were no significant differences between the groups for change in impairment (as measured by grip strength, range of motion of wrist flexion and extension and pain intensity), activity limitation and participation restriction, as measured by the Patient-Rated Wrist Evaluation (PRWE). Exercise and advice given by a physiotherapist were equally as effective as activity-focussed physiotherapy in recovery both at 6 and 24 weeks. Conclusion: The results suggest that after removal of cast from fracture of distal radius, patients may routinely require no more than a single session of advice and exercise provided by a physiotherapist.