腕关节镜辅助下切开复位经骨窗植骨内固定治疗桡骨远端die－punch骨折

目的:探讨腕关节镜辅助下切开掌侧经骨窗撬拨复位植骨内固定治疗桡骨远端(Die punch)骨折的临床疗效。方法:自2016年3月至2017年3月,采用腕关节镜辅助下切开复位经骨窗植骨内固定治疗桡骨远端Die punch骨折患者12例,男8例,女4例;年龄20～42岁。术前X线片及CT明确诊断为桡骨远端Die punch骨折。观察患者关节活动度情况,术后12个月采用VAS评分评价疼痛缓解程度,采用Cooney腕关节评分对患者腕关节功能恢复情况进行评估。结果:全部患者无手术并发症,12例患者术后均获随访,时间10～13个月。术后12个月VAS评分0～3分。腕关节掌倾角5°～15°,尺偏角14°～23°,屈伸活动度123°～168°,前臂旋转活动度115°～170°。术后12个月Cooney腕关节评分70～95分;优10例,良1例,可1例。结论:腕关节镜辅助下切开掌侧经骨窗撬拨复位植骨内固定治疗桡骨远端Die punch骨折,术后手腕部功能恢复良好,疼痛症状较轻,临床效果满意。     

锁定加压钢板内固定联合植骨治疗Barton骨折

目的 探讨应用锁定加压接骨板(LCP)联合支撑植骨治疗Bartoll骨折的临床疗效.方法 2002年6月-2008年1月,对30例Barton骨折患者,采用切开复位支撑植骨LCP内固定法治疗.术后早期进行合适的康复锻炼.结果 术后30例均获得3-24个月的随访,平均12个月.术后X线片显示骨折全部愈合.掌倾角6°～16°,平均10.4°;尺偏角17°～25°,平均20.1°.桡骨纵向无短缩.采用腕关节功能及X线片测量指标进行综合评定:优20例,良8例,差2例;优良率达93.3%.结论 应用锁定加压钢板内固定联合支撑植骨治疗Banon骨折,能最大限度地恢复桡骨与尺骨的相对长度、掌倾角及尺偏角,关节面平整.术后配合合理的康复锻炼,能使腕关节功能达到最大的恢复.     

π型钢板内固定加植骨术治疗中青年桡骨远端粉碎性骨折

目的 探讨π型钢板内固定加植骨术治疗中青年桡骨远端严重粉碎性骨折的效果.方法 2005年1月至2008年5月收治并获得随访的中青年桡骨远端严重粉碎性骨折21例,根据AO分型:A3型5例,C2型7例,C3型9例.术前掌倾角为-34°～21°,平均-15°;尺偏角-10°-21°,平均14.5°;桡尺骨相对长度-2.0～0.5 cm,平均-1.2 cm.均采用π型钢板内固定加自体髂骨移植术,术后平均石膏托外固定6周后行功能锻炼.术后摄X线片观察骨折愈合情况,测量术前、术后掌倾角、尺偏角及桡尺骨远端相对长度.结果 术后随访9～18个月,平均13.5个月;骨折愈合时间3～8个月,平均6.2个月;术后掌倾角为8°～170°,平均13.2°;尺偏角为16°～29°,平均22.7°;桡尺骨相对长度为0.9～1.6 cm,平均1.3 cm.骨折愈合拆除内固定后:前臂旋前60°～87.,平均75.0°;旋后72°～97°,平均87.7°.术后腕关节功能采用Gartlant和Werley标准评分:优13例,良6例,可2例,优良率为90.5%,未出现肌腱断裂、感染、骨不连等并发症.结论 π型钢板内固定加自体骨移植术是治疗中青年桡骨远端粉碎性骨折的一种有效方法.     

掌侧T型锁定钢板联合桡骨茎突钢板治疗C型桡骨远端骨折

目的探讨掌侧T型锁定钢板联合桡骨茎突钢板治疗C型桡骨远端骨折的疗效。方法 2010年5月-2011年5月,采用掌侧T型锁定钢板联合桡骨茎突钢板内固定治疗C型桡骨远端骨折24例。男8例,女16例;年龄23～73岁,平均52岁。摔伤20例,交通事故伤4例。左侧15例,右侧9例。均为新鲜闭合骨折。根据AO分型:C2型16例,C3型8例。术前掌倾角—60～25°,平均—45.3°;尺偏角—16～13°,平均8.2°;桡骨短缩8～18 mm,平均12 mm。伤后至手术时间3～10 d,平均5.2 d。结果术后切口均Ⅰ期愈合。24例均获随访,随访时间9～16个月,平均13.5个月。X线片示骨折均愈合,愈合时间8～12周,平均10.2周。关节面平整,桡骨长度恢复。掌倾角8～15°,平均12.3°;尺偏角18～26°,平均22.3°。随访期间未发生复位丢失、原骨折部位再骨折、腕管综合征等并发症。末次随访时患者腕关节活动范围:背伸30～70°,平均45.3°;掌屈26～78°,平均50.2°;桡偏8～25°,平均13.5°;尺偏15～32°,平均23.6°;旋前35～90°,平均65.7°;旋后20～90°,平均72.5°。腕关节功能按照Gartland-Werley评分方法评定:获优12例,良8例,中4例;优良率83.3%。结论掌侧T型锁定钢板联合桡骨茎突钢板内固定可重建正常解剖结构,临床效果良好,是治疗C型桡骨远端骨折的有效方法之一。     

切开复位经骨窗植骨内固定治疗桡骨远端B4型骨折

目的:探讨切开掌侧经骨窗撬拨复位植骨内固定治疗桡骨远端B4型骨折的临床疗效。方法:自2015年1月至2016年6月,采用切开掌侧经骨窗撬拨复位植骨内固定治疗桡骨远端B4型骨折患者13例,男9例,女4例;年龄18～36岁,平均26.3岁。骨折按AO/OTA分型为B4型。观察骨折愈合、术后并发症情况,并于术后12个月时采用VAS评分评价其疼痛缓解程度,采用Cooney腕关节评分对患者术后功能恢复情况进行评价。结果:13例患者术后获随访,时间10～14个月,平均12.4个月。骨折全部愈合,时间4～6个月,平均5.2个月。术后12个月Cooney腕关节评分,优10例,良2例,可1例。VAS评分为1.0±1.1,握力占健侧比率(88.2±2.7)%,掌倾角(12.2±3.8)°,尺偏角(19.3±5.4)°,腕关节屈伸活动度(118.1±2.3)°,前臂旋转活动度(158.0±13.0)°。术后无骨关节炎发生及相应并发症发生。结论:采用经掌侧骨窗撬拨复位植骨内固定治疗桡骨远端B4型中舟月关节面塌陷压缩型骨折,临床效果满意,术后并发症少,是治疗此类骨折的有效方法之一。     

掌侧锁定加压钢板治疗背侧不稳定桡骨远端骨折的临床研究

目的初步探讨掌侧锁定加压钢板(LCP)固定治疗背侧不稳定桡骨远端骨折的方法及其效果。方法回顾性分析掌侧LCP结合克氏针撬拨、植骨等技术治疗背侧不稳定桡骨远端骨折35例,比较研究手术前后掌倾角、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9～24个月(平均17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20例,良12例,可2例,差1例。结论对背侧不稳定桡骨远端骨折,掌侧LCP是一种安全有效的治疗方法,可有效防止复位丢失、减少结构性植骨、避免肌腱激惹等。     

植骨在桡骨远端骨折治疗中的支撑作用

目的探讨植骨方法在不稳定性桡骨远端骨折治疗中的支撑作用。方法2001年10月～2004年10月,对17例桡骨远端骨折患者应用植骨方式进行支撑,加用钢板内固定治疗,术后评估腕关节功能及骨愈合状况。结果术后平均随访14.6个月,所有患者均获得骨性愈合,腕关节功能按改良Mcbride评分及纽约骨科医院腕关节评估标准:优9例,良5例,一般3例,优良率为82.3%。结论通过应用自体骨植骨支撑的方法,有利于恢复腕关节正常解剖结构,降低创伤性关节炎的发生率。     

桡骨远端Barton骨折的微创治疗

目的探讨桡骨远端Barton骨折微创治疗的可行性。方法采用自行设计的新型外固定器,结合经皮撬拨、有限切开复位和经皮克氏针固定等微创技术治疗桡骨远端Barton骨折18例。结果术后3、12个月腕关节的活动范围较对侧正常腕关节相比无差异,桡骨高度和尺偏角较对侧正常腕关节相比无差异,掌倾角分别恢复53·7%、52·8%,小于对侧正常腕关节。Sarmiento功能评分:优11例,良5例,一般2例。结论新型外固定器能有效维持桡骨远端骨折的复位,使桡骨远端骨折的微创治疗成为可能。     

钢板预置关节镜复位技术(PART)治疗桡骨远端骨折

目的 研究使用钢板预置关节镜复位技术(PART)治疗桡骨远端骨折,将腕掌侧锁定钢板技术与腕关节镜有效结合,提高C型桡骨远端骨折(AO分型)的治疗效果.方法 自2009年2月～2011年7月使用PART技术对13例桡骨远端C型骨折进行手术治疗,行桡骨远端骨折切开复位后予克氏针及预置掌侧锁定钢板临时固定骨折,在腕关节镜下对关节面处骨折行进一步复位,满意后用钢板螺钉将骨折完全固定.结果 桡骨远端关节面台阶移位及水平移位均在2 mm内.掌倾角0～15°,平均13.4°,尺偏角17～26°,平均22.3°.桡骨远端高度无短缩.采用Gartland和Werley评分标准对腕关节功能进行评价:优8例,良4例,中1例.结论 PART技术治疗桡骨远端C型骨折,将腕掌侧锁定钢板技术与腕关节镜有效简便结合,提高了关节面骨折复位水平,骨折固定坚强,可早期进行腕关节功能锻炼,临床效果优异.     

复杂桡骨远端骨折的手术治疗

目的 探讨手术治疗复杂桡骨远端骨折的疗效.方法 对65例复杂桡骨远端骨折根据骨折类型及特点,采用切开复位关节面,植骨支撑桡骨远端关节面,恢复掌倾角、尺偏角,应用钢板、克氏针、外固定架等方法 联合固定.随访观察骨折愈合时间、腕关节活动范围,术后掌倾角、尺偏角的平均角度.结果 本组随访时间8～24个月,平均12.5个月.所...     

Condylar blade plate fixation of unstable fractures of the distal ulna associated with fracture of the distal radius

PURPOSE: To review the results of condylar blade plate fixation of unstable fractures of the distal ulna associated with fracture of the distal radius. METHODS: Twenty-four patients in whom a minicondylar blade plate was used to repair an unstable fracture of the distal ulna associated with a fracture of the distal radius were reviewed retrospectively an average of 26 months (range, 12-50 months) after injury. According to the Q modifier of the Comprehensive Classification of Fractures, there were 1 simple fracture of the ulnar neck (Q2), 20 comminuted fractures of the ulnar neck (Q3), and 3 fractures of the head and neck (Q5). Subsequent surgeries included repeat fixation and autogenous cancellous bone grafting in 2 patients with nonunion of the distal radius and 1 with nonunion of the distal ulna. Seven patients had a second operation to remove the ulnar plate secondary to discomfort from plate prominence. RESULTS: The final average motion was as follows: degrees of flexion (range, 30 degrees-80 degrees), 52 degrees of extension (range, 40 degrees-90 degrees), 76 degrees of pronation (range, 45 degrees-90 degrees), and 70 degrees of supination (range, 45 degrees-90 degrees). Grip strength averaged 64% of the contralateral, uninjured extremity (range, 35%-100%). Final radiographic measurements included an average palmar tilt of the distal articular surface of the radius of 8 degrees (range, 0 degrees-20 degrees of palmar tilt), ulnar inclination of 21 degrees (range, 15 degrees-25 degrees), and ulnar positive variance of 1 mm (range, 0-4 mm). There were no problems related to the distal radioulnar joint. According to the system of Gartland and Werley as modified by Sarmiento, there were 6 excellent, 15 good, and 4 fair results at final evaluation. CONCLUSION: For unstable fractures of the distal ulna associated with fracture of the distal radius, condylar blade plate fixation can achieve healing with good alignment, satisfactory function, and an acceptable rate of secondary surgery.     

Treatment of the unstable distal radius fracture with external fixation and a hydroxyapatite spacer

A prospective study was performed on 25 patients (15 women, 10 men) with unstable fractures of the distal radius selectively treated with a dynamic type of external fixation combined with a hydroxyapatite spacer. The fractures ranged from type VI to type VIII according to Frykman's classification. The patients' mean age at surgery was 49 years (range, 19-75 years). The mean follow-up period was 2.5 years, and overall outcome was assessed using Gartland and Werley's demerit point system as modified by Sarmiento. Radial inclination was 26 degrees +/- 4 degrees at the time of reduction and 26 degrees +/- 5 degrees at follow-up, palmar tilt was 9 degrees +/- 2 degrees at reduction and 8 degrees +/- 3 degrees at follow-up, and ulnar variance was 1.4 +/- 0.6 mm at reduction and 2.1 +/- 0.9 mm at follow-up. The mean range of motion at follow-up was 80 degrees +/- 10 degrees in flexion, 80 degrees +/- 10 degrees in extension, 85 degrees +/- 10 degrees in supination, and 80 degrees +/- 5 degrees in pronation. The outcome in 24 of 25 patients was evaluated as excellent. In the surgical treatment of unstable fractures of the distal radius using external fixator, the fracture reduction should be supported with bone graft or a bone substitute, and a hydroxyapatite spacer was considered to be a useful substitute for a bone graft.     

掌侧锁定加压接骨板治疗桡骨远端不稳定性骨折

目的评价切开复位锁定加压接骨板（LCP）内固定治疗桡骨远端不稳定性骨折的效果。方法对21例桡骨远端不稳定性骨折采用掌侧入路切开复位LCP内固定治疗。其中5例做了植骨。结果21例均获随访,时间6～19（13．0±3．9）个月,患者骨折均愈合。桡骨远端的掌倾角平均9．6°±3．7°;尺偏角平均21．4°±2,3°;桡骨短缩≥2mm2例,其余皆〈2mm;关节面移位均〈1mm。用改良的Gartland和Werley评分系统评估腕关节功能：优14例,良5例,中1例,差1例。结论切开复位掌侧LCP内固定是治疗桡骨远端不稳定性骨折的有效方法,辅以植骨能有效防止关节面塌陷和促讲骨折愈合。     

外固定架在桡骨远端不稳定骨折治疗中的应用

目的 总结桡骨远端不稳定骨折外固定架治疗的效果。方法 本组28例均采用外固定架固定，其中19例应用克氏针固定，4例因骨缺损较严重同时植骨。结果 随访时间3—22个月，按改良的Mcbride评分标准，远期疗效优良者25例，优良率89．28％。结论 桡骨远端不稳定骨折手法复位较困难，并因石膏外固定难以维持复位而常发生再移位。这类骨折应尽早手术复位，外固定架固定是理想的手术方法之一，术后配合合理有效的功能锻炼，可以获得较好的效果。对远期功能影响最大的因素是桡骨短缩程度和关节解剖复位的满意程度。     

外固定架在小儿桡骨远端骨折中的应用

目的探讨手法复位结合外固定架治疗小儿桡骨远端骨折的效果。方法应用手法复位外固定架治疗28例不稳定性桡骨远端骨折,骨折愈合后拆除外固定架。结果28例均获随访,时间6～14个月,骨折临床愈合时间6～8周。末次随访时按Cooney腕关节评分系统（包括疼痛、功能状况、腕关节活动度、握力）：优15例,良11例,可2例。结论手法复位外固定架治疗小儿桡骨远端骨折能使骨折复位、固定满意,避免骨骺损伤,利于术后早期手和腕部的功能康复锻炼,是治疗小儿桡骨远端骨折的有效方法。     

The operative treatment of intraarticular Smith fractures

Twenty-one intraarticular palmar displaced fractures of the distal radius operated on between 1990 and 1995 were reviewed with a mean follow-up of 27.3 months (range, 8-54). Fifteen fractures were treated with palmar T-plates, two in combination with an external fixator. Five fractures were treated with external fixators and K-wires, and one fracture was treated with percutaneous K-wires and a cast. In six patients cancellous bone graft from the iliac crest was used. The most satisfactory clinical and radiological results were obtained by anatomical reconstruction of the articular surface. The favoured method remains stabilization with palmar T-plates. K-wires with a cast should only be used in simple articular fractures with a large palmar fragment.     

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。     

Sagittal wrist motion of carpal bones following intraarticular fractures of the distal radius

Forty patients (mean age, 37 years) with intraarticular C2 and C3 Colles fractures were treated by open reduction, internal fixation and bone grafting. At a mean follow-up of 8 years radiocarpal and midcarpal motion was evaluated, the depth of the articular surface of the distal radius in the sagittal plane was measured and the presence of arthritis was noted. The fractures healed with a mean palmar tilt of 6 degrees , a mean ulnar tilt of 18 degrees and ulna variance within 1 mm of the contralateral side. The depth of the articular surface of the distal radius was 1.3 mm greater than the uninvolved side. Measurement of carpal bone angles relative to the radius in maximum flexion and extension revealed lunate extension of 23 degrees , lunate flexion of 15 degrees , capitate extension of 62 degrees , capitate flexion of 40 degrees . There was a significant correlation between articular surface depth and radiocarpal motion.     

Complications following internal fixation of unstable distal radius fracture with a palmar locking-plate

OBJECTIVES: The increasing number of fixed-angle plate systems used to treat distal radius fractures carries with it the problem of determining the optimal fixation for unstable fractures. Our goal was to analyze the clinical and radiological outcomes of patients with displaced, unstable distal radius fractures treated with a palmar fixed-angle plate. DESIGN: Prospective protocol; multicenter clinical study; retrospective analysis. SETTING: Level 1 university trauma centers. PATIENTS: Over a mean 15-month period (range, 12 to 27 months), 141 consecutive patients were treated for an unstable dorsally displaced distal radius fracture of which 114 or 81% were followed for 1 year or longer. INTERVENTION: Open reduction and palmar internal fixation with a fixed-angle plate (2.4 mm LCP Distal Radius Plates; Synthes, Salzburg, Austria). Indication for surgical treatment was the inability to obtain or maintain fracture or articular alignment after initial closed reduction. MAIN OUTCOME MEASURES: In a follow-up period, which had to be longer than 12 months, objective and subjective functional results (active range of motion; strength; Disabilities of the Arm, Shoulder, and Hand (DASH) score; visual analog scale (VAS); Green and O'Brien Score) and radiographic assessment (palmar tilt, radial inclination, ulnar variance, fracture union) were assessed. Potentials for complications were given special attention. RESULTS: In the 114 patients followed for a minimum of 12 months, there were 21 men and 93 women with a mean age of 57 years (17 to 79 years). Fractures were classified according to the AO/ASIF classification system as type A2 (n = 39), A3 (n = 16), C1 (n = 24), C2 (n = 30), or C3 (n = 5). The modified Green and O'Brien Score revealed 31 excellent, 54 good, 23 fair, and 6 poor results. Active wrist motion averaged 54 degrees extension (82% as compared with the uninjured side) and 46 degrees flexion (72% as compared with the uninjured side). The average pronation was 81 degrees (95% as compared with the uninjured side), and the average supination was 82 degrees (95% as compared with the uninjured side). Mean grip strength at final follow-up was 70% of the uninjured side. Low residual pain values in the wrist were demonstrated: 81 patients (71%) were pain free, 17 patients (15%) had mild pain, 10 patients (9%) had moderate pain, and 6 patients (5%) had severe pain. The DASH score averaged 13 points (range, 0 to 39 points). Fracture union was achieved in all patients. A mean loss of palmar tilt of 3.4 degrees (range, 0 to 8 degrees), radial inclination of 0.4 degrees (range 0 to 2 degrees), and of the ulnar variance of 1.2 mm (range, 0 to 6 mm) was measured. The overall complication rate was 27% (31/114). The most frequent problems were flexor and extensor tendon irritation (57% of the total number of complications), including 2 ruptures of the flexor pollicis longus tendon, 2 ruptures of the extensor pollicis longus tendon, 4 cases of extensor tendon tenosynovitis, and 9 cases of flexor tendon tenosynovitis. Carpal tunnel syndrome was observed in 3 patients, and complex regional pain syndrome occurred in 5 patients. In 2 cases, loosening of a single screw was seen. Delayed fracture union occurred in 3 patients, and intraoperative intraarticular screw displacement was recognized in 1 patient. Neither clinical outcome nor complication rate were dependent on fracture type (intraarticular versus extraarticular). CONCLUSION: Fixation of unstable dorsally displaced distal radius fractures with a fixed angle plate provides sufficient stability with minimal loss of reduction. Nevertheless, very distal palmar plate position can interfere with the flexor tendon system, too long screws can penetrate the extensor compartments, and distal screws in comminuted fracture patterns can cut through the subchondral bone and penetrate into the radiocarpal joint. Mindful of these problems, we consider that the complex fracture pattern of an unstable distal radius fracture cannot be treated by a single plate system and approach.     

Injectable calcium phosphate bone cement Norian SRS for the treatment of intra-articular compression fractures of the distal radius in osteoporotic women

BACKGROUND: Distal radius fracture often presents a metaphyseal void which is more extended in elderly, osteoporotic patients. Bone graft and bone substitutes are reported to be beneficial in maintaining metaphyseal reduction. METHODS: We performed a prospective study on 52 menopausal, osteoporotic women with unstable intra-articular distal radius fractures to compare the outcome of percutaneous pinning and immobilisation in a cast for 6 weeks with that using injectable calcium phosphate bone cement (Norian Skeletal Repair System, SRS) to supplement pin and screw fixation and immobilisation in a cast for 3 weeks. All patients were reviewed 2 years (range 21-29 months) after surgery. RESULTS: Patients treated with SRS had better functional outcome, restoration of movement and grip strength ( p<0.001). In this group there was 1 mm loss of radial length, 3 degrees loss of radial inclination and 7 degrees loss of palmar tilt. In the control group radial length decreased 3 mm, radial inclination decreased 11 degrees and palmar tilt 12 degrees. Loss of reduction was significantly higher in the control group ( p<0.001). CONCLUSION: We conclude that the use of Norian SRS to supplement pin and screw fixation is effective in maintaining the reduction of unstable intra-articular distal radius fractures in osteoporotic patients and provides a better clinical outcome than percutaneous pinning.