有限切开复位克氏针内固定联合外固定架治疗桡骨远端粉碎性骨折

目的:探讨桡骨远端粉碎性骨折有限切开复位克氏针内固定联合动力跨关节型外固定架的治疗效果。方法:应用有限切开复位内固定结合动力跨关节型外固定架治疗28例桡骨远端粉碎性骨折,骨折愈合后拆除外固定架。结果:随访6～24个月,平均12个月。按照Dienst腕关节功能系统评定:优16例,良9例,可3例,优良率为89.3%。结论:有限切开复位克氏针内固定联合外固定架固定治疗桡骨远端粉碎性骨折既能使骨折复位、固定满意,又有利于术后早期手腕部的功能康复锻炼。     

不同方法治疗老年桡骨远端骨折临床研究

目的:探讨手法复位石膏固定、克氏针十外固定架固定、切开复位钢板固定治疗老年桡骨远端骨折的临床疗效.方法:收治108例135侧60岁以上的老年桡骨远端骨折患者,手法复位石膏固定71侧,外固定架加克氏针固定34侧,切开复位钢板固定30侧,随访比较不同治疗方法的疗效.结果:患者随访10～24个月,平均13个月,腕关节功能按Dienst评估标准进行评估,手法复位石膏外固定组优良率76.1％,外固定架加经皮穿针固定组优良率85.2％,切开复位钢板固定组优良率76.7％.外固定支架结合有限内固定组疗效明显优于手法复位石膏固定或切开复位钢板内固定组,手法复位石膏固定组和切开复位钢板内固定组无显著性差异.结论:对于老年桡骨远端骨折,外固定支架结合有限内固定组疗效明显优于手法复位石膏固定或切开复位钢板内固定组.     

46例桡骨远端粉碎骨折手术治疗

2001年1月-2004年12月，笔者对桡骨远端粉碎骨折闭合复位不满意者，采用切开复位“T”型纯钛金属板螺钉固定，切开复位外固定架固定及切开复位克氏针内固定加外固定架固定等方法，对46例桡骨远端粉碎骨折进行手术治疗，取得满意疗效，现报告如下。     

有限切开外固定架结合克氏针治疗桡骨远端粉碎性骨折

目的:总结有限切开外固定架结合克氏针治疗桡骨远端粉碎骨折的体会。方法:对桡骨远端粉碎骨折按AO分类为C型的患者,32例采用有限切开外固定架结合克氏针治疗。结果:随访6～24个月,均获骨性愈合,腕关节功能优良率85.4%。结论:采用有限切开外固定架结合克氏针技术对于治疗桡骨远端粉碎性骨折可收到较好效果。     

应用外固定器治疗桡骨远端不稳定性骨折的临床观察

目的探讨桡骨远端不稳定骨折微创治疗的可能性。方法采用前臂(经腕关节型)外固定器为基础治疗,结合有限切开复位和克氏针固定等微创技术治疗桡骨远端不稳定性骨折22例。结果患者经上述治疗后骨折均完全愈合,功能良好;腕关节功能按改良Shea评定法进行评分,随访6～9个月(平均7.5个月),结果优14例,良4例,中4例,差0例,优良率为81.82%;与对侧正常腕关节比较,患侧腕关节的活动范围、桡骨高度和尺偏角差异无统计学意义,掌倾角恢复略小。结论采用前臂(经腕关节型)外固定器结合有限切开复位和克氏针固定等微创技术能有效维持桡骨远端不稳定性骨折的复位,是治疗桡骨远端骨折的一种有效方法。     

克氏针结合可调式外固定架治疗桡骨远端骨折32例

目的 :探讨克氏针结合可调式外固定架治疗桡骨远端骨折的疗效及可行性;方法:对复杂性桡骨远端骨折32例使用克氏针结合可调式外固定架,将克氏针针针尾留于皮外,1²月后拔除,手术均行术中X线C型臂透视,14例闭合复位,18例切开复位,采用Gartland评分对手术效果及预后进行评价。结果:32例患者均获得随访,随访时间112月后拔除,手术均行术中X线C型臂透视,14例闭合复位,18例切开复位,采用Gartland评分对手术效果及预后进行评价。结果:32例患者均获得随访,随访时间11²3个月,平均16个月,优26例,良5例,1例因针道感染于术后1个月取除外固定,改支具,经处理后愈合。结论:克氏针结合可调式外固定架治疗桡骨远端骨折,具有疗效肯定、治疗简单,周期较短,创伤较小,避免二次手术等特点。     

17例有限内固定结合AO外固定架治疗桡骨远端粉碎性骨折临床观察

为探讨有限内固定结合AO外固定架在桡骨远端粉碎性骨折的治疗效果，对17例粉碎性桡骨远端骨折的患者采取克氏针或T型钢板结合AO外固定架固定、植骨治疗。结果：骨折愈合时间6～8周，无针道感染、骨不连和外固定松动，随访1例桡骨关节面塌陷，骨折成角，其余恢复良好。提示有限内固定结合AO外固定架治疗桡骨远端粉碎性骨折具有良好的固定作用，术后配合有效的功能锻炼可以获得满意的治疗效果。     

桡骨远端粉碎骨折行切开复位有限内固定的疗效分析

目的 探讨切开复位有限内固定结合外固定治疗桡骨远端涉及关节面粉碎性骨折的疗效.方法 31例桡骨远端涉及关节面的粉碎骨折患者行切开复位克氏针简单内固定术,术后2～4周作短时间外固定,结合积极有效的辅助功能锻炼.结果 经7～17个月的随访,骨折愈合率100%.按Gartland的临床功能评分标准,功能优良率达93.5%;X线解剖复位优良率达96.8%.结论 切开复位克氏针有限内固定加术后短时间外固定,可以解剖复位粉碎的桡骨远端关节面,术后位置维持良好,功能恢复佳,手术简单,损伤小,是治疗桡骨远端涉及关节面粉碎骨折的较好治疗方法.     

外固定架治疗桡骨远端粉碎性骨折疗效分析

目的探讨应用外固定架治疗桡骨远端粉碎性骨折的临床疗效。方法对2004年4月～2007年6月收治的30例桡骨远端粉碎性骨折应用外固定架治疗行回顾性分析。本组均为C2、C3型骨折，在C臂下复位，外固定架固定。必要时切开复位，辅助克氏针固定碎骨块。结果本组所有患者骨折愈合，腕关节功能按TAM标准：优18例，良9例，可2例，差1例，优良率87％。结论外固定架治疗桡骨远端严重粉碎性骨折仍是一种有效的治疗方法。     

外固定架结合克氏针与锁定钢板内固定治疗桡骨远端C型骨折的疗效对比

目的:比较外固定架结合克氏针与锁定钢板内固定治疗桡骨远端C型骨折的临床疗效。方法:选取2007年2月-2014年1月在本院接受治疗的38例C型桡骨远端骨折患者作为研究对象,按照手术方案不同分为A组(采用外固定架结合克氏针固定)与B组(采用掌侧入路切开复位、锁定钢板内固定)。两组患者骨折的AO分型:A组21例,其中C1型5例、C2型8例、C3型8例;B组17例,其中C1型5例、C2型5例、C3型7例。术后定期复查X线片,骨折愈合后对腕关节的功能进行Dienst评分。结果:随访时间为4~13个月,平均8.6个月,骨折愈合时间为3~8个月,平均5.3个月。A组有2例发生针道感染,2例出现克氏针松动、退针。B组2例发生骨折复位后丢失、螺钉进入关节腔。A、B组的C1、C2型骨折间的优良率差异无统计学意义(P>0.05),C3型骨折A组优于B组(P<0.05)。结论:对于闭合性桡骨远端C1、C2型骨折,可选择外固定架结合克氏针固定或锁定钢板内固定术,而对于C3型骨折,选择外固定架结合克氏针固定术疗效相对较佳。     

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.     

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。     

AO支撑钢板内固定治疗桡骨远端粉碎性骨折

目的探讨手术内固定治疗桡骨远端粉碎性骨折的疗效.方法对28例手法复位失败的桡骨远端粉碎性骨折(包括Colles骨折、Smith's骨折、Bartons骨折),行切开复位、AO支撑钢板内固定,并进行定期随访.结果均获骨性愈合,无伤口感染、骨不连、内固定断裂脱出等并发症.根据改良Grenand O'Brien临床评定标准综合评定,优20例,良8例.结论对于手法复位失败的桡骨远端粉碎骨折,切开复位、AO支撑钢板内固定能获得满意的治疗效果.     

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.     

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.     

桡骨远端骨折治疗的研究进展

桡骨远端骨折是常见的骨折之一,多发于中老年和青少年。多种方法可以用来治疗桡骨远端骨折,有观点坚持钢板内固定内固定比夹板、石膏外固定能更早地活动及功能锻炼;也有观点认为克氏针、外固定支架固定能将开放手术的风险降低;对于老年人,骨质疏松多见,建议对此人群行闭合手法复位石膏、夹板或支具外固定。常用的固定及材料为石膏夹板或支具外固定、经皮穿刺闭合克氏针固定、外固定支架固定、内固定、植入人工腕关节假体。而内固定种类包括接骨板、骨折特异性固定、背侧牵引接骨板、髓内钉等。切开复位内固定两种传统的手术入路分为掌、背侧入路。近年来骨替代物、腕关节镜辅助、3D 打印应用于桡骨远端骨折。桡骨远端骨折治疗方法多样,每种治疗方法都有其适用特点及优缺点,而且治疗需据骨折类型、年龄、活动水平进行个体化定制,本文对其进行综述。