手法复位加小夹板钢托外固定治疗桡骨远端骨折

目的:评价手法复位结合小夹板外固定治疗桡骨远端骨折的近期临床疗效。方法:2015年1月至2016年12月,采用手法复位并行小夹板钢托外固定治疗桡骨远端骨折患者60例,男39例,女21例;年龄18~65(43.50±10.56)岁;按AO分型,A型38例,B型19例,C型3例。骨折复位前及复位后1、2、4周及拆除小夹板钢托时行腕关节正侧位X线检查,并测量其患侧掌倾角、尺偏角、桡骨高度。骨折复位后8、24、48周测量患侧腕关节背伸、掌屈、旋前、旋后、尺偏、桡偏活动度,骨折复位后、复位后4、8、24、48周测量健侧和患侧腕关节握力。桡骨远端骨折达到临床愈合后拆除小夹板钢托,拆除小夹板钢托后进行腕关节Mayo评分。结果:60例桡骨远端骨折患者全部完成随访,骨折愈合时间6~8(7.1±0.9)周。掌倾角、尺偏角、桡骨短缩距离,复位前与复位后2周时比较,差异有统计学意义;复位后2周与4周比较,差异无统计学意义。复位后24周和8周,48周与24周时腕关节背伸、掌屈、旋前、旋后、尺偏、桡偏活动度比较,差异有统计学意义。患者复位后与复位后4周,复位后8周与4周,复位后16周与8周,复位后24周与16周时握力比较,差异有统计意义;复位后48周与24周时握力评分比较,差异无统计学意义。采用Mayo腕关节功能评分系统评价疗效,优50例,良8例,可1例,差1例。结论:手法复位加小夹板钢托外固定治疗桡骨远端骨折,操作简单,临床疗效确切。     

桡骨远端不稳定型骨折的微创治疗

目的评估桡骨远端不稳定型骨折微创治疗的手术疗效。方法对64例桡骨远端不稳定型骨折患者进行回顾性研究,在手术后1～3年,测定腕关节的活动范围和影像学指标,对腕关节功能进行Gartland-Werley评分。结果患侧腕关节的背伸和尺偏活动范围显著小于正常腕关节（P〈0.05）,掌曲、桡偏、旋前和旋后活动范围与正常腕关节无显著性差异（P〉0.05）。掌倾角显著小于正常腕关节（P〈0.01）,桡骨高度和尺偏角无显著性差异（P〉0.05）。Gartland-Werley功能评分优良率为90.6%。结论闭合复位,外固定支架结合经皮克氏针固定能有效治疗桡骨远端不稳定型骨折。     

掌侧锁定加压钢板与外固定支架治疗不稳定桡骨远端C型骨折的比较研究

目的比较研究掌侧锁定加压钢板（LCP）与外固定支架固定治疗不稳定桡骨远端C型骨折的疗效及适应证。方法2000年1月-2006年6月分别采用外固定支架和掌侧LCP结合克氏针撬拨、植骨等技术治疗不稳定桡骨远端C型骨折61例（85侧），骨折按AO／ASIF分型：C1型28侧，C2型33侧，C3型24侧。其中掌侧LCP治疗组34侧，外固定支架固定组51侧。比较两组手术前后掌倾角、尺偏角、桡骨短缩及关节活动范围等，初步评价其临床疗效。结果所有患者经6～27个月（平均16个月）随访。掌倾角、尺偏角、桡骨短缩及关节面均获明显改善。腕关节功能按Gartland—Werlev标准评定，C1、C2型骨折LCP组优于外固定支架组，差异有统计学意义（P〈0．05）；C3型骨折两组差异无统计学意义（P〉0．05）。结论对于掌侧或背侧不稳定的C1、C2型桡骨远端骨折，掌侧LCP可提供有效固定及早期活动；背侧不稳定的C型桡骨远端骨折是外固定支架的最佳适应证；严重粉碎的C3型骨折（尤其掌侧不稳定者）应联合运用LCP和外固定支架等技术。     

跨腕关节外固定器治疗不稳定性桡骨远端骨折

目的 回顾分析闭合复位、单侧外固定器跨腕关节固定治疗不稳定性桡骨远端骨折的效果。方法 2000年6月～2005年3月，利用外固定器跨腕关节固定治疗45例50侧不稳定性桡骨远端骨折，年龄15～78岁（平均44．8岁）。骨折按AO分型：A3型5例5侧，B3型4例4侧，C1型3例3侧，C2型9例9侧，C3型24例29侧。手法或外固定器协助复位，外固定器静力性固定，骨折愈合后拆除外固定器。随访8～48个月（平均20个月）。结果 骨折愈合时间6～8周，平均7．6周。4例4侧出现针道表浅感染，经口服抗生素及局部换药后好转。最后一次随访时，影像学评估（Stewan改良的Sarmiento评分）：优39例42侧，良6例8侧。腕关节功能按Garland与Werley功能评分标准：优34例37侧，良8例9侧，可3例4侧，优良率为92％。结论 闭合复位、单侧外固定器跨腕关节静力性固定桡骨远端骨折，通过选择合适的外固定针置入部位，可以避免桡神经损伤及第二掌骨医源性骨折，减少针道感染及松动等并发症的发生，并有利于术后早期行手部功能锻炼；无需辅助性植骨促进骨折愈合，是不稳定性桡骨远端骨折的有效治疗方法。     

内外固定治疗桡骨远端不稳定骨折的临床对照研究

目的：探讨复位外固定器治疗桡骨远端不稳定骨折的疗效。方法：采用配对设计,回顾性分析了2005年8月至2009年9月收治的60例桡骨远端不稳定骨折患者,其中男8例,女52例;年龄34-85岁,平均60．27岁;左侧33例,右侧27例。所有骨折为自行摔倒后手撑地所致,均为闭合性骨折。按AO分型：A3型22例,B2型4例,B3型2例,C1型20例,C2型8例,C3型4例。分别采用切开复位钢板内固定及闭合复位外固定器治疗。观察术前术后掌屈、背伸、桡偏、尺偏、旋前、旋后、握力、掌倾角、尺偏角及桡骨短缩。结果：60例均获随访,时间12-18个月,平均15．4个月。桡骨高度：外固定组平均（4．85±2．75）mm,内固定组平均（4．29±1．53）mm;掌倾角：外固定组平均（14．66±10．77）。,内固定组平均（14．39±5．01）。;尺偏角：外固定组平均（7．90±4．70）。,内固定组平均（6．19±3．15）。。两组比较差异均无统计学意义（P〉0．05）。内固定组与外固定组功能比较,除旋后及桡偏外,其余指标差异无统计学意义（P≥0．05）。采用Batra腕关节评分标准测定两组患者术后1年腕关节功能,外固定组Batra解剖评分平均86-27分,其中优15例,良11例,可1例,差3例;功能评分平均94．93分,均为优。内固定组Batra解剖评分平均91．27分,其中优16侧,良12例,可2例;功能评分平均94-23分,均为优。结论：复位外固定器与钢板内固定治疗桡骨远端不稳定骨折疗效相近,无明显差异。     

桡骨远端骨折畸形愈合的原因及对腕关节功能的影响

目的分析不同治疗方法导致桡骨远端骨折畸形愈合的原因。改善腕关节功能。方法191例桡骨远端骨折者分别行石膏外固定（A组）、外固定架固定（B组）、切开复位内固定（C组）治疗,分析骨折畸形愈合的原因。结果骨折畸形愈合42例,A组畸形愈合发生率高于B组、C组（P〈0．05）;Logistic回归分析显示,桡骨短缩（OR=4．31）、桡腕关节面移位（OR=1．21）与骨折畸形愈合相关;畸形愈合者腕关节功能优良率低于愈合完善者（P〈0．05）。结论桡骨短缩、桡腕关节面移位易引发骨折畸形愈合,临床应选择合理的固定方式重建桡骨解剖结构。改善腕关节功能。     

平乐郭氏正骨联合小夹板外固定对老年桡骨远端骨折患者掌倾角及腕关节功能的影响

目的：探讨平乐郭氏正骨联合小夹板外固定对老年桡骨远端骨折（DRF）患者掌倾角及腕关节功能的影响。方法：回顾性分析2019年3月—2022年4月本院收治的103例老年DRF患者的临床资料,根据复位手法的不同分成常规复位组（n=51,常规手法复位）、中医复位组（n=52,平乐郭氏正骨手法复位）,两组复位后均予以小夹板外固定。比较两组腕关节尺偏角、掌倾角、腕关节主动活动度（AROM）及腕关节功能恢复效果。结果：两组腕关节尺偏角、掌倾角均随治疗时间增加而减小（P <0.05）,尺偏角的组间与时点无交互作用（P>0.05）,掌倾角的组间与时点存在交互作用（P <0.05）,其中中医复位组治疗后即刻、6周及12周的尺偏角、掌倾角均明显大于常规复位组（P <0.05）;治疗后12周,两组患侧腕关节背伸、掌屈、旋后时的AROM均大于治疗前,且中医复位组均明显大于常规复位组（P <0.05）;中医复位组腕关节功能恢复优良率为96.15%,明显高于常规复位组的82.35%,差异有统计学意义（P <0.05）。结论：对老年DRF患者实施平乐郭氏正骨联合小夹板外固定治疗,可...     

手术与非手术治疗桡骨极远端骨折对腕关节运动轴线影响的比较

目的观察并比较采用手术与非手术治疗桡骨极远端骨折对患者腕关节运动轴线的影响。方法回顾性分析自2015-01—2016-02诊治的25例桡骨极远端骨折,手术组15例(12例采用切开复位T形钢板内固定,3例骨折手法复位后采用外固定架固定),非手术组10例于手法复位后用石膏或小夹板外固定。结果 25例均获得随访,随访时间平均3(2~5)个月。与非手术组比较,手术组掌倾角、尺偏角、桡骨高度恢复更满意,患侧握力占健侧握力百分比更高,上肢功能障碍DSAH量表评分更低,差异有统计学意义(P0.05)。结论相对于手法复位石膏或小夹板外固定,切开复位钢板内固定和外固定架固定治疗桡骨极远端骨折的稳定性好,可维持骨折复位并最大限度减少掌倾角、尺偏角、桡骨高度的丢失,恢复桡腕关节运动轴线。     

桡骨远端不稳定骨折44例治疗分析

目的评价外固定架与切开复位内固定治疗不稳定性桡骨远端骨折的疗效。方法44例桡骨远端复杂骨折分别采用切开复位桡骨掌侧钢板内固定、外固定支架两种手术方法治疗。其中内固定组26例,外固定支架组18例。术后复查X线片,测量桡骨高度和掌倾角、尺偏角。采集术后1、12个月采用改良Gartland—Werley（GW）评分方法评定两组患者的腕关节功能。结果所有患者均得到随访,时间12—16个月,平均13．1个月。术后测量影像学参数,桡骨高度：内固定组平均（8．24±0．12）mm,外固定支架组平均（8．57±0．22）mm;掌倾角：内固定组平均（8．76±0．16）度,外固定支架组平均（8．12±0．31）度;尺偏角：内固定组平均（18．61±1．08）度,外固定支架组平均（17．89—1．41）度。相比差异无统计学意义（P〉0．05）。内固定组GW评分与外固定支架组,两者相比差异无统计学意义（P〉0．05）。结论两种方法治疗后腕关节功能无明显差异。     

小夹板联合外固定架治疗桡骨远端不稳定骨折

目的探讨小夹板联合外固定支架固定治疗桡骨远端不稳定性骨折的临床疗效。方法选取自2011年4月至2013年10月收治的桡骨远端不稳定性骨折患者160例,按照随机数字表法分为观察组和对照组各80例。对照组给予外固定支架治疗,观察组给予外固定支架联合小夹板外固定治疗。观察两组的骨折复位维持情况(桡骨前倾角、尺偏角、缩短恢复情况)、骨折愈合情况,放射学Lidstrom分级,腕关节功能Gartland-Werle评分分级。结果两组治疗前后桡骨前倾角、尺偏角、缩短情况、骨折愈合时间、放射学Lidstrom分级比较差异无统计学意义(P0.05);观察组Gartland-Werley腕关节功能评分优良率明显高于对照组,差异具有统计学意义(χ2=3.745,P0.05)。结论桡骨远端不稳定性骨折复位后外固定支架的早期固定牢固可靠,骨折愈合相对稳定时改用小夹板固定可有效解决患肢的早期功能锻炼问题,两种固定手段相结合获得了较好的临床效果,值得临床推广。     

超肘小夹板与传统小夹板固定治疗粉碎性Colles骨折的病例对照研究

目的 :观察比较超肘小夹板与传统小夹板固定治疗粉碎性Colles骨折的固定效果和临床疗效。方法 :2013年10月至2015年10月门诊收治52例粉碎性Colles骨折患者,分传统夹板组和超肘夹板组,超肘夹板组男7例,女19例;年龄38~85岁,平均(64.615±11.475)岁。骨折AO分型:A3型3例,C1型9例,C2型7例,C3型7例。传统夹板组男9例,女17例;年龄36~91岁,平均(65.269±13.162)岁。骨折分型:A3型4例,C1型8例,C2型9例,C3型5例。各组施行手法复位后,传统夹板组以传统前臂小夹板超腕固定,超肘夹板组前3周加用上肢直角板固定肘关节,3周后去除直角板,同传统夹板组固定方法继续固定至骨折愈合。定期复查X线,骨折达临床愈合拆除夹板,并观察X线下桡骨愈合后与复位后相比的短缩长度和掌倾角改变度数。积极功能康复锻炼8周后两组患者参照改良Green和O’Brien临床评分标准进行疗效评分。结果 :所有患者骨折临床愈合,并获得随访,平均随访时间8~12周,未发现严重并发症。骨折愈合后桡骨短缩长度:超肘夹板组(2.962±1.248)mm,传统夹板组(5.923±1.978)mm,传统夹板组短缩大于超肘夹板组(P0.05)。掌倾角改变:超肘夹板组(4.692±2.950)°,传统夹板组为(5.192±3.371)°(P0.05)。腕关节功能评分:超肘夹板组(89.615±11.482)分,传统夹板组(80.385±13.485)分,超肘夹板组得分高于传统夹板组(P0.05)。结论 :超肘小夹板固定治疗粉碎性Colles骨折比传统前臂四夹板固定效果更可靠,患腕关节功能恢复更优良。     

Dorsal bridge plating versus bridging external fixation for management of complex distal radius fractures

IntroductionDistal radius fractures are the most frequent upper limb injuries encountered by orthopedic surgeons. Surgical treatment of distal radius fractures is preserved for unstable and displaced fractures. A randomized controlled trial was conducted to compare the radiological and functional outcomes of bridge plating (BP) to external fixation (EF) in comminuted intra-articular distal radius fractures.MethodsSixty patients with distal radius fractures were eligible for treatment by means of ligamentotaxis using either a dorsal bridge plate (30 patients) or an external fixator (30 patients) with or without supplementary Kirschner wires (K-wires). Radiological evaluation was done using the radial inclination angle, radial length, and the volar tilt. Clinical evaluation was performed using ranges of wrist motion, grip strength, Visual Analogue Scale (VAS), and a validated Arabic version of the Disability of the Arm, Shoulder, and Hand (DASH) questionnaireResultsPatients were followed up for 12 months. No significant difference was found in terms of radiographic parameters or ranges of wrist motion. At 3-months follow-up, bridge plating group had stronger grip strength, lower Disability of the Arm, Shoulder, and Hand scores, and lower Visual Analogue Scale. However, both groups had similar functional outcomes at last follow-up. External fixation group had a higher rate of postoperative complications.ConclusionIn comparison to external fixation, bridge plating may provide earlier functional recovery with lower complication rates. However, no functional or radiological superiority were demonstrated at 12-months follow-up.     

Dynamic vs static external fixation of distal radial fractures: A randomized study

Objectives:

The present randomized study is conducted to compare the functional and anatomical outcomes of dynamic multiplanar external fixation against that of static external fixation in the management of displaced unstable comminuted fractures of the distal radius.

Materials and Methods:

Sixty adult patients with displaced unstable comminuted fractures of the distal radius were randomly allocated either to the dynamic (n=30) or static (n=30) fixator groups. Patients in the dynamic fixator group were managed with closed reduction and application of Penning-type articulated fixator (Orthofix, Srl, Italy); the injured wrist was partially dynamized at 3 weeks. Patients in the static group were managed with monoplanar static external fixator of Joshi''s external stabilizing system (JESS) type fixator. In both groups, the fixator was maintained for 6–8 weeks. The patients were followed-up over 2 years. The primary outcome measures were the functional outcome as measured using the Gartland and Werley and DASH scores and anatomical outcome as measured using the Lindstrom score. The secondary objective was to correlate anatomical and functional outcomes and to look at overall local complications.

Results:

Palmar tilt was better restored in the Penning fixator group (P<0.0001). There was reduced loss of ulnar tilt (P=0.05) and radial height (P=0.04) in the Penning fixator group. Gartland and Werley score was better in the Penning fixator group at each time point of the follow-up. The DASH score was similar in the two groups at 2 years (P=0.14). There was poor correlation (0.19) between functional outcome and anatomical restoration at 2 years.

Conclusions:

In the management of displaced unstable comminuted fracture of the distal radius, use of an articulated multiplanar external fixator, allowing partial dynamization of the injured wrist at 3 weeks, resulted in improved early functional and anatomical outcome as compared to static external fixation. However, there was no significant difference in functional outcome at 2 years.     

不同方法治疗老年桡骨远端粉碎性骨折的比较研究

目的对比分析手法复位石膏外固定、有限内固定加外固定架固定和掌侧斜T形钢板内固定治疗老年桡骨远端粉碎性骨折的疗效。方法2000年1月～2004年9月,我院共收治178例60岁以上老年桡骨远端粉碎性骨折患者,手法复位石膏外固定102例,闭合或小切口复位克氏针有限内固定加外固定架固定46例,掌侧斜T形钢板内固定30例,随访比较不同治疗方法的疗效。结果所有患者随访13～52个月,平均27个月,按Dienst功能评估标准进行评定,手法复位石膏外固定组优良率为78.4%,有限内固定加外固定架固定组优良率为93.5%,掌侧斜T形钢板内固定组优良率为80.0%,有限内固定加外固定架固定组疗效明显优于石膏外固定及掌侧斜T形钢板固定组,差异有极显著性意义(P<0.01);石膏外固定与掌侧斜T形钢板固定组间疗效无显著差异(P>0.05)。结论对于老年桡骨远端粉碎性骨折,有限内固定加外固定架固定组疗效优于手法复位石膏外固定组和钢板内固定组。     

A comparative study of variable angle volar plate and bridging external fixator with K-wire augmentation in comminuted distal radius fractures

Purpose: Comminuted intraarticular distal radial fractures are difficult to treat conservatively and require operative treatment. This study compared the functional outcomes between variable angle volar plating and external fixator with K-wire augmentation in open reduction and internal fixation. Methods: A total of 62 adult patients with comminuted intraarticular distal radius fracture were randomized into 2 groups: volar plate group and external fixator group. These patients aged between 18 and 60 years had unilateral fractures, and agreed to be included in the study. Patients with a history of fracture, bilateral fracture, associated other injuries, delayed injury for more than 2 weeks, open fracture, pre-existing arthrosis or disability, psychiatric illness and pathological fracture were excluded. Patients were followed up at 6 weeks, 3 months, 6 months and 1 year. The assessment of pain, functional activity, range of motion and grip strength was done at each stage of follow-up. The pain and functional activities were assessed by patient rated wrist evaluation (PRWE) score and disabilities of the arm, shoulder and hand (DASH) score. Results: Patients in volar plate group had superior PRWE score and DASH score at each stage of followup. At 1 year follow-up, the mean PRWE score were 7.48 for volar plate group and 7.35 for external fixator group; while the mean DASH score was 4.65 for volar plate group and 5.61 for external fixator group. They had better flexion and extension range of movement. They also had better pronation and supination range of motion at initial follow-up, however the difference get attenuated by 1 year. Volar plate group had significantly better grip strength than external fixator group. Complication rates were higher in external fixation group. Conclusion: Fixation with variable angle volar plate results in early wrist mobilization, better range of movement, less pain and disability and early return of function.     

外固定支架结合掌侧入路治疗桡骨远端关节面骨折

目的探讨外固定支架结合掌侧人路治疗桡骨远端关节面骨折的手术指征及临床疗效。方法2000年3月～2005年3月，收治桡骨远端关节面骨折28例，采用背侧外固定支架固定于功能位，掌侧入路以钢板或克氏针固定；骨皮质粉碎或松质骨压缩者予植骨。其中男21例，女7例；年龄18～54岁，中位年龄41岁。左侧4例，右侧24例。根据AO分型标准：C2型18例，C3型10例。合并月骨周围脱位1例。结果4例失访，24例获随访6～18个月，平均8．5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11．2°，尺偏角19～28°，平均20．8°，均无丢失。按照改良Mcbride评分和纽约骨科医院腕关节评估标准，优16例，良5例，可3例，优良率87％。结论不稳定桡骨远端骨折以及闭合复位难以纠正者应手术治疗。掌侧入路固定能降低并发症，结合外固定支架可获满意复位及功能。     

桡骨远端C型骨折掌侧锁定钢板与外固定架的疗效比较

目的比较掌侧锁定钢板与外固定架治疗桡骨远端C型骨折的疗效。方法采用随机对照法,纳入2014年10月到2017年10月收治的桡骨远端C型骨折患者,随机分为两组,分别采用外固定架或者掌侧锁定钢板治疗。比较两组患者手术时间、术中出血量、骨折愈合时间、术后并发症发生率;比较末次随访时患者腕关节活动度、桡骨掌倾角、尺偏角;比较健、患侧握力比值和患侧腕关节Gartland-Werley评分。结果共纳入30例患者,其中外固定架组14例,掌侧锁定钢板组16例。两组患者术后均随访1年。结果显示,掌侧锁定钢板组手术时间长于外固定架组,术中出血量多于外固定架组,但末次随访时桡骨掌倾角、尺偏角恢复水平优于外固定架组(P<0.05);两组骨折愈合时间,末次随访时腕关节屈伸、旋转活动度,健、患侧握力比,患侧腕关节Gartland-Werley评分等,均未见明显统计学差异(P>0.05);两组患者均未发生术后并发症。结论对于桡骨远端C型骨折,外固定架治疗的手术风险小于掌侧锁定钢板,但会造成术后一定程度的复位丢失,然而这种复位丢失并不影响患者的腕关节功能恢复。     

外固定架治疗桡骨远端粉碎性骨折的临床观察

目的：评价外固定支架治疗桡骨远端粉碎性骨折的临床疗效。方法：自2008年3月至2009年12月,应用外固定支架或辅以克氏针、“T”形交锁加压钢板（T—LCP）治疗桡骨远端粉碎性骨折37例,男14例,女23例;年龄30-79岁,平均59．1岁。根据AO分型：Cl型3例,C2型11例,C3型23例。术后定期进行X线和腕关节功能评估。结果：37例患者均获得随访,时间8-24个月,平均12个月,均临床愈合,平均愈合时间8周。根据Gratland—Werley标准进行功能评价：优16例,良17例,可4例,优良率89．0％。结论：外固定支架治疗桡骨远端粉碎性骨折可取得满意的临床疗效。     

Monitoring of the first stages of bone healing with microdialysis

Background and purpose Promising results have been reported after volar locked plating of unstable dorsally displaced distal radius fractures. We investigated whether volar locked plating results in better patient-perceived, objective functional and radiographic outcomes compared to the less invasive external fixation.

Patients and methods 63 patients under 70 years of age, with an unstable extra-articular or non-comminuted intra-articular dorsally displaced distal radius fracture, were randomized to volar locked plating (n = 33) or bridging external fixation. Patient-perceived outcome was assessed with the Disability of the Arm, Shoulder, and Hand (DASH) questionnaire and the Patient-Rated Wrist Evaluation (PRWE) questionnaire.

Results At 3 and 6 months, the volar plate group had better DASH and PRWE scores but at 12 months the scores were similar. Objective function, measured as grip strength and range of movement, was superior in the volar plate group but the differences diminished and were small at 12 months. Axial length and volar tilt were retained slightly better in the volar plate group.

Interpretation Volar plate fixation is more advantageous than external fixation, in the early rehabilitation period.