桡骨远端骨折锁定接骨板内固定掌侧入路保留旋前方肌与Henry入路疗效比较

目的 比较桡骨远端骨折锁定接骨板内固定中保留旋前方肌的掌侧入路与Henry入路手术的临床疗效.方法 回顾性分析自2017-01-2019-12采用锁定接骨板内固定治疗的128例桡骨远端骨折,68例采用保留旋前方肌的掌侧入路手术(掌侧组),60例采用Henry入路手术(Henry组).比较2组手术时间、骨折显露时间、术中...     

掌侧小切口与Henry入路锁定钢板内固定治疗AO-C型桡骨远端骨折的疗效比较

目的比较掌侧小切口复位与Henry入路切开复位锁定钢板内固定治疗AO-C型桡骨远端骨折的临床疗效。方法回顾性分析自2015-01—2018-01行切开复位锁定钢板内固定治疗的36例AO-C型桡骨远端骨折,16例采用掌侧小切口入路(微创入路组),20例采用Henry入路(Henry入路组)。比较2组切口长度、手术时间、术中出血量、骨折愈合时间、末次随访时腕关节功能Dienst评分。结果 36例均获得随访,随访时间平均16.5(12～38)个月。与Henry入路组比较,微创入路组切口长度更短,术中出血量更少,手术时间与骨折愈合时间缩短,差异有统计学意义(P 0.05);但是2组末次随访时腕关节功能Dienst评分比较差异无统计学意义(P0.05)。结论掌侧小切口与Henry入路复位锁定钢板内固定治疗AO-C型桡骨远端骨折均可取得良好的临床疗效,采用掌侧小切口入路复位固定具有切口小、术中出血少、软组织损伤小、骨折愈合快、并发症少等优点,在一定程度上加快了患者的康复。     

改良掌侧入路掌侧锁定钢板治疗桡骨远端骨折的疗效

目的 探讨改良掌侧入路(Henry入路)掌侧锁定钢板治疗桡骨远端骨折的临床疗效。方法 采用改良Henry入路掌侧锁定钢板治疗170例桡骨远端骨折患者。记录末次随访时患者腕关节活动度、前臂旋转度、影像学指标、疼痛VAS评分、握力等情况,采用Quick DASH评分、PRWE评分、Mayo评分评价疗效。结果患者均获得随访,时间12～36个月。末次随访时,腕关节活动度:背伸45°～70°,掌屈35°～65°,桡偏25°～30°,尺偏30°～45°;前臂旋转度:旋前80°～95°,旋后75°～95°;影像学指标:掌倾角5°～20°,尺偏角15°～30°;疼痛VAS评分0～3分,握力13～45 kg,Quick DASH评分0～29分,PRWE评分0～26分,Mayo评分70～99分。末次随访时,腕关节尺偏、前臂旋后、尺偏角、握力方面<65岁年龄段优于≥65岁年龄段(P <0.05);腕关节背伸、腕关节掌屈、腕关节桡偏、前臂旋前、掌倾角、疼痛VAS评分、Quick DASH评分、PRWE评分和Mayo评分方面两年龄段比较差异均无统计学意义(P> 0.05)。术后出现26例并发症...     

比较掌侧和背侧入路锁定钢板内固定治疗不稳定性桡骨远端骨折的效果

目的比较掌侧和背侧入路锁定钢板内固定治疗不稳定性桡骨远端骨折的效果。方法根据不同手术入路将接受锁定钢板内固定治疗的94例不稳定性桡骨远端骨折患者分为2组,各47例。对照组采用背侧入路,观察组采用掌侧入路。回顾性分析患者的临床资料。结果术后2组患者的尺偏角、掌倾角均优于术前,差异有统计学意义(P0.05);但2组差异无统计学意义(P0.05)。观察组术后并发症发生率较对照组低,差异有统计学意义(P0.05)。术后随访1 a,依据Mcbridgi评分标准,观察组腕关节优良率为87.23%,对照组为85.11%,2组差异无统计学意义(P0.05)。结论掌侧入路与背侧入路锁定钢板内固定治疗不稳定性桡骨远端骨折,均有良好复位效果,但掌侧入路的并发症少,安全性较高。     

掌侧入路锁定加压钢板内固定治疗桡骨远端不稳定骨折效果分析

目的探讨对桡骨远端不稳定骨折患者应用掌侧入路锁定加压钢板内固定治疗的临床效果。方法选取2015-04—2018-04间开封东原康复医院收治的48例桡骨远端不稳定骨折患者,均实施掌侧入路锁定加压钢板内固定治疗。回顾性分析患者的临床资料。结果 48例患者术后均获随访12～28个月,平均16.50个月。骨折愈合时间为(15.16±3.20)周。未出现骨延迟愈合及骨不连、感染、内固定松动断裂、腕管综合征、正中神经损伤等其他并发症。术后12个月复查结果显示,掌倾角为(7.40°±1.70°),尺偏角为(18.80°±2.60°)。桡骨茎突高度为(11.20±2.76)mm。依据Sarmiento评价标准评定腕关节功能,本组优良率为91.67%。结论掌侧入路锁定加压钢板内固定治疗桡骨远端不稳定骨折,固定牢固、解剖复位理想、骨折愈合率高、并发症风险小、腕关节功能恢复理想。     

Henry入路保留旋前方肌掌侧锁定加压钢板内固定术治疗桡骨远端不稳定骨折效果分析

目的 探讨Henry入路保留旋前方肌掌侧锁定加压钢板(LCP)内固定术治疗桡骨远端不稳定骨折的效果。方法 回顾性分析郑州中心医院骨科于2018-03—2020-09行Henry入路掌侧LCP内固定术的62例桡骨远端骨折患者的临床资料。分为切开旋前方肌组(A组,32例)和不切开旋前方肌组(B组,30例)。比较2组手术时间、术中出血量、骨折愈合时间,以及术后4周、3个月、6个月时的腕关节活动度、前臂旋转范围、握力。术后6个月按照Gartland-Werlery评分标准评价腕关节功能。结果 B组手术时间、术中出血量、骨折愈合时间均少(短)于A组,差异有统计学意义(P<0.05)。术后4周、3个月时,B组患者的腕关节屈伸、旋转活动范围、握力均大于A组,差异均有统计学意义(P<0.05)。术后6个月时2组患者的腕关节屈伸、旋转活动范围、握力,以及腕关节功能优良率差异均无统计学意义(P>0.05)。结论 Henry入路保留旋前方肌掌侧LCP内固定术治疗桡骨远端不稳定骨折,可保留旋前方肌的解剖结构和生理功能,减少术中出血量,缩短术后骨折愈合时间,有利于腕关节功能早期恢复。     

掌侧入路锁定钢板内固定治疗不稳定桡骨远端骨折疗效分析

目的探讨掌侧入路锁定钢板内固定治疗不稳定桡骨远端骨折的临床疗效。方法采用掌侧入路锁定钢板内固定治疗不稳定桡骨远端骨折27例。结果随访时间6~12个月,优15例,良8例,可2例,差2例,优良率85.18%。结论采用掌侧入路锁定钢板内固定治疗不稳定桡骨远端骨折具有操作简单、固定牢固可靠、有利于早期功能锻炼、腕关节功能恢复满意的优点。     

掌侧入路T形钢板内固定治疗桡骨远端不稳定骨折

目的探讨掌侧入路T形钢板治疗桡骨远端不稳定骨折的疗效及注意事项。方法选择手法复位失败或粉碎性骨折的桡骨远端不稳定骨折28例,采用掌侧入路T形钢板内固定治疗,术后进行定期随访并进行回顾性分析。结果所有骨折于3个月内愈合,根据患者主诉、腕关节外形、功能及X线征象进行临床分析。结果优19例,良8例,可1例,优良率96.4%。结论掌侧入路T形钢板内固定治疗桡骨远端不稳定骨折具有固定确切,能早期活动,功能恢复好,并发症少等优点。     

掌侧入路锁定钢板治疗桡骨远端不稳定性骨折32例临床分析

目的总结经掌侧入路切开复位锁定钢板内固定治疗桡骨远端不稳定性骨折的体会,并观察疗效。方法对32例桡骨远端不稳定性骨折患者实施掌侧入路切开复位锁定钢板内固定手术,术后行早期功能锻炼。随访6~12个月,观察手术效果。结果本组患者骨折愈合时间(8.3±2.3)个月。依据Fernandez标准评价腕关节功能:优23例,良6例,可3例,优良率93.75%。X线片复查结果显示掌倾角、尺偏角及桡骨长度恢复良好。均未发生钢板断裂、松动及骨不连等并发症。结论对桡骨远端不稳定性骨折患者实施掌侧入路切开复位锁定钢板内固定手术,复位良好、固定牢固、并发症低,有利于关节功能的恢复,并可有效保持掌倾角、尺偏角及桡骨长度处于合理范围。     

Minimally invasive plate osteosynthesis for distal radius fractures

Background:

Fractures of distal radius are common injury in all age groups. Cast treatment with or without close reduction is a viable option. However, the results are often unsatisfactory with restricted function. The open reduction and internal fixation often results in extensive soft tissue dissection and associated high rates of infect and delayed/nonunion. The distractor/external fixator have reported good functional and anatomical results but the incidence of pin traction infection nerve injury and cosmedic deformity are high. We introduced a modified operative technique for minimally invasive plate osteosynthesis (MIPO) for distal radial fracture and evaluated the functional outcomes and complications.

Materials and Methods:

22 distal radial fractures (10 left, 12 right) were treated using the MIPO technique and two small incisions with a palmar locking plate from August 2009 to August 2010. The wrist function was assessed according to Dienst wrist rating system, and postoperative complications were recorded.

Results:

According to Dienst wrist rating system, 13 patients showed excellent results, 6 cases showed good results and 3 patients had moderate results. No patient had poor results. Thus, the excellent and good rate was 86.4%. One patient had anesthesia in the thenar eminence and this symptom disappeared after 3 months. One patient had delayed healing in the proximal wrist crease. Two patients had mild pain on the ulnar side of the wrist and two patients had limited wrist joint function.

Conclusion:

The MIPO technique by using two small palmar incisions is safe and effective for treatment of distal radial fractures.     

Henry入路掌侧解剖锁定钛板治疗桡骨远端C型骨折

目的探讨Henry入路掌侧解剖锁定钛板治疗桡骨远端C型骨折的临床效果。方法自2010—03—2013-05采用Henry入路掌侧解剖锁定钛板治疗桡骨远端C型骨折73例，根据AO／ASIF分型：C1型骨折35例，C2型骨折26例，C3型骨折12例。结果所有患者均获得随访，时间10～18个月，平均12．9个月。所有骨折均达到骨性愈合，无感染、背侧肌腱激惹症状、腕管综合征、内固定失效等并发症发生。根据Dienst关节功能评估标准：优37例，良30例，可6例，优良率为91．8％；按照改良的McBride评分腕关节评估标准评定：优35例，良31例，可7例，优良率90．4％。结论Henry入路掌侧解剖锁定钛板治疗桡骨远端C型骨折，骨折复位固定满意，术后并发症少，有利于早期功能锻炼，值得临床推广。     

Henry入路蝶形钢板内固定治疗桡骨远端双柱Die-punch骨折

目的:探讨Henry入路蝶形钢板切开复位内固定治疗桡骨远端双柱Die-punch骨折的临床疗效。方法:选择2018年1月至2021年6月采用Henry手术入路切开复位内固定治疗的26例桡骨远端双柱Die-punch骨折患者,男14例,女12例;年龄20～75(44.2±3.4)岁。观察术后并发症情况,术后12个月采用Gartland-Werley评分标准进行腕关节功能评价。结果:26例患者均获得随访,时间10～18(13.4±0.8)个月。所有骨折均获得骨性愈合,时间8.5～15.8(11.4±0.5)周。所有患者手术切口都Ⅰ期愈合,无伤口感染、血管神经损伤及内固定失效等病例。术后12个月GarthndWerley评分(3.65±0.36)分,优16例,良8例,可2例。结论:通过掌侧Henry入路,使用蝶形钢板切开复位内固定治疗桡骨远端双柱Die-punch骨折,可获得满意的临床疗效。     

桡骨远端骨折掌侧钢板螺钉内固定术中保留旋前方肌对疗效的影响

目的 探讨桡骨远端骨折掌侧钢板螺钉内固定术中保留旋前方肌对临床疗效的影响.方法 回顾性分析自2015-01-2018-11采用掌侧钢板螺钉内固定治疗的90例桡骨远端骨折,45例在术中保留旋前方肌(观察组),45例在术中切开旋前方肌并进行修复(对照组),比较两组术后12个月桡骨茎突高度、掌倾角、尺偏角以及腕关节背伸、掌屈...     

锁定钢板微创治疗胫骨远端骨折的疗效分析

目的探讨应用经皮解剖型锁定钢板内固定术治疗胫骨远端骨折的方法及疗效。方法采用经皮微创解剖型锁定钢板内固定治疗术治疗胫骨远端骨折30例。结果 30例随访10～24个月,未出现骨折延迟愈合及不愈合,根据Mazuretal的踝关节症状和功能评价标准,优良率为93.3%。结论应用经皮微创解剖型锁定钢板内固定治疗胫骨远端骨折,具有手术创伤小,骨折愈合快,术后并发症少,肢体功能恢复良好等特点。解剖型锁定钢板内固定术是治疗胫腓骨远端骨折的一种理想内固定方法。     

微创技术与传统入路锁定钢板内固定治疗老年肱骨近端骨折的疗效比较

目的比较手法复位微创技术(MIPO)锁定钢板内固定与传统入路锁定钢板内固定治疗老年肱骨近端骨折的临床疗效。方法回顾性分析自2010-03—2014-09诊治的85例肱骨近端骨折,40例采用手法复位MIPO技术锁定钢板内固定(微创组),45例经传统胸三角肌入路切开复位锁定钢板内固定(传统组)。比较2组切口长度、手术时间、术中出血量、术后引流量、手术前后血红蛋白差值、住院时间、骨折愈合时间、并发症、Constant-Murley肩关节功能评分、VAS评分和EQ-5D健康指数。结果 85例获得平均22.6(12~48)个月随访。微创组的切口长度、手术时间、术中出血量、术后引流量、手术前后血红蛋白差值、骨折愈合时间、术后3个月Constant-Murley评分,以及术后1周、3个月VAS评分和EQ-5D健康指数均优于传统组,差异有统计学意义(P0.05)。而2组住院时间及术后1年的Constant-Murley评分、VAS评分和EQ-5D健康指数差异无统计学意义(P0.05)。2组并发症发生率比较差异无统计学意义(χ2=1.497,P=0.221)。结论手法复位后经三角肌入路MIPO技术锁定钢板内固定治疗老年肱骨近端骨折在切口长度、手术时间、术中出血量、骨折愈合时间、早期缓解肩关节疼痛、功能恢复及改善生活质量等方面均明显优于传统入路锁定钢板内固定,临床效果良好。     

掌侧锁定钢板治疗桡骨远端不稳定骨折

目的探讨掌侧锁定钢板治疗桡骨远端不稳定骨折的治疗效果。方法对56例桡骨远端不稳定骨折患者采用切开复位掌侧锁定钢板内固定治疗,其中13例复位后骨缺损严重者行人工骨植骨。结果 56例均获随访,时间13~24个月。X线片显示骨折全部愈合。按Gadand-Werley评分标准:优12例,良33例,可10例,差1例。发生腕管综合征4例,拇伸肌腱激惹3例,局部疼痛1例。结论掌侧锁定钢板能有效维持桡骨远端不稳定骨折的复位,但存在各种并发症,处理得当基本能获得满意的腕关节功能。     

Complication rates and reduction potential of palmar versus dorsal locking plate osteosynthesis for the treatment of distal radius fractures

Background

The aim of this study was to evaluate the complication rates of volar versus dorsal locking plates and postoperative reduction potential after distal radius fractures.

Materials and methods

For this study 285 distal radius fractures (280 patients/59.4 % female) treated with locked plating were retrospectively evaluated. The mean age of the patients was 54.6 years (SD 17.4) and the mean follow-up was 33.2 months (SD 17.2). The palmar approach was used in 225 cases and the dorsal approach in 60 cases (95 % type C fractures).

Results

Adequate reduction was achieved with both approaches, regardless of fracture severity. In the dorsal group, the complications and implant removal rates were significantly higher and the operative time was also longer.

Conclusions

Based on these facts, we advocate the palmar locking plate for the vast majority of fractures. In cases of complex multifragmentary articular fractures where no compromise in reduction is acceptable, and with the biomechanical equality of palmar and dorsal plating remaining unproven, dorsal plating may still be considered.

Level of evidence

Therapeutic level IV.     

掌侧T形锁定加压接骨板治疗老年桡骨远端骨折

目的:评价应用掌侧T形锁定加压接骨板(T-locking-compression plate,T-LCP)治疗老年桡骨远端骨折的临床疗效,探讨老年骨质疏松症桡骨远端骨折的手术必要性。方法:自2003年1月-2006年3月,应用T形锁定加压接骨板掌侧入路治疗老年桡骨远端骨折23例,骨折类型均为AO分型的B、C型;男7例,女16例,年龄60~78岁,平均66岁。术后进行腕关节功能随访,X线片观察。结果:21例获得随访,随访时间6~18个月,平均9个月。X线示骨折全部愈合。桡骨远端关节面掌倾角平均为4.5°,尺倾角为19.2°。桡骨茎突较尺骨茎突长0.85cm。按关节功能评估标准进行评分:优11例,良7例,可3例,优良率达85.7%(18/21)。结论:老年骨质疏松性桡骨远端骨折(AO-B、C型)有手术必要性,掌侧T-LCP内固定是有效的手术方法之一,具有固定可靠、退钉率低、早期恢复腕关节功能的优点。     

Minimally invasive locking plate osteosynthesis for fractures of the distal tibia--results in 20 patients

AIMS: We report our experiences with minimally invasive locking plate osteosynthesis (MILPO), for distal tibia fractures, with specific reference to fracture union and complications encountered. PATIENTS AND METHODS: Twenty patients underwent MILPO for open and closed distal tibia fractures between March 2003 and December 2004. Fractures were classified according to the AO system. Open fractures were graded using the Gustilo and Anderson classification and closed fractures via the Tscherne classification system. RESULTS: There were 16 males and 4 females of mean age 44.7 years (range 19-69 years). Thirteen patients had temporary external fixation, prior to definitive fracture fixation. Minimum follow-up was 12 months and average time to full weight bearing in the closed fracture group (12 patients) was 18.1 weeks (range 8-32 weeks) and 19.3 weeks in the open fracture group (8 patients, range 8-44 weeks). Fracture healing was defined as radiological evidence of bridging mature callus combined with pain-free full weight bearing. In the open fracture group, four fractures united within 6 months, one within 6-12 months and one united 12 months after surgery; there were two cases of non-union. In the closed fracture group, seven fractures united within 6 months, three fractures between 6 and 12 months and two after 12 months from surgery. Two of the 20 patients required additional procedures to aid bone healing in the post-operative period. Three of the 20 patients required metalwork removal, for delayed wound breakdown in two cases and wound infection in one case. An uneventful recovery was made following this, in all three cases. There was one case of implant failure due to plate breakage at 32 weeks post-op. The fracture site was opened and re-plated at 32 weeks with a DCP. There were no complications following this. CONCLUSION: MILPO was used for definitive fixation of high energy, open and closed, peri-articular distal tibia fractures. This approach aims to preserve bone biology and minimise surgical soft tissue trauma. This surgical approach may provide an answer to treating a challenging group of fractures and further research is warranted.