结构性植骨在复杂桡骨远端骨折骨缺损中的应用

目的 探讨采用结构性自体髂骨移植治疗高能量损伤所致伴有关节面的塌陷与干骺端粉碎缺损的桡骨远端骨折的疗效。 方法 选取2007年1月-2010年10月就诊的桡骨远端骨折(AO分类C3型)患者38例，克氏针临时维持固定，使桡腕关节面、桡骨远端长度、掌倾角最大限度恢复。根据骨缺损的形态，取自体3层皮质骨髂骨块嵌入软骨下骨支撑植骨，并取少量松质骨植骨填塞顶压塌陷关节面，尽可能使关节面解剖复位，重建桡骨远端解剖形态。采用改良Gartland和Werley评分标准评定腕关节功能恢复情况。 结果 随访12～ 38个月，无钢板断裂和医源性神经血管损伤。本组骨折愈合时间15～22周，平均18.3周。部分患者经功能康复锻炼后腕关节功能明显改善。按改良Garland和Werley功能评估系统进行疗效评定，优良率为87％。随访中2例患者桡骨远端高度进行性丢失，2例患者桡腕关节面中央凹陷型塌陷，有严重的腕关节屈伸功能障碍。 结论高能量损伤所致复杂桡骨远端骨折需恢复桡腕关节面、桡骨远端长度、掌倾角，采用结构性自体髂骨移植能有效支撑植骨和维持桡腕关节面的平整，恢复桡骨远端的解剖形态，促进腕关节功能的恢复。

Structural bone graft for treatment of complicated distal radius fractures and bone defects

Objective To investigate the curative effect of structural bone graft in treatment of high energy injury-induced complicated distal radius fractures combined with articular surface collapse and comminuted epiphyseal bone defect. Methods The study involved 38 patients with distal radius fractures (AO classification, type C3) treated from January 2007 to October 2010.The patients were treated with temporary Kirschner wire fixation to recover the wrist articular surface, distal radius length and palmar tilt angle at the greatest possibility.According to the form of the bone defects, the iliac bone taken from three layers of the cortical bone was embedded in the subchondral bone to support the bone graft, and a small amount of cancellous bone graft was collected to fill the articular surface collapse as much as possible for anatomical reduction of the articular surface, and anatomical form of the distal radius was reconstructed.Modified Sarmiento Gartland and Werley evaluation systems were used to evaluate the articular function recovery. Results The follow-up lasted for 1-3.2 years, which showed no complications such as plate rupture or iatrogenic nerve blood vessels injuries.The fracture healing time was 15-22 weeks (mean 18.3 weeks).The wrist articular function in some patients obtained obvious improvement through functional rehabilitation training.According to the modified Gartland and Werley function evaluation systems, the curative effects reached excellence rate of 87％.During follow-up, there were two patients with high progressive loss in the height of the distal radius and two with articular surface collapse and severe carpal joint flexion and extension dysfunction. Conclusions The high energy injury-induced distal radius fractures with articular surface collapse and epiphyseal bone defect need recovery of the wrist articular surface, distal radius length and palmar tilt angle.Structural bone graft can effectively support the grafted bone and maintain the flatness of the radiocarpal articular surface, restore the anatomy of the distal radius and facilitate the functional recovery of the wrist.