外固定架结合有限切开复位克氏针内固定治疗桡骨远端骨折的解剖学和临床研究

目的探讨外固定架结合有限切开复位克氏针内固定治疗桡骨远端骨折的解剖学和临床方面的意义。方法通过对前臂及手部的解剖学观察及测量，分别找出桡骨远端骨折外固定支架螺钉和克氏针进针的安全区域和合理角度，并且做出体表定位，以此制定标准化术式，并应用于临床，对临床病例进行随访，观察临床疗效。结果第二掌骨处外固定支架螺钉的进钉部位为两端偏桡背侧；骨折近端外固定支架螺钉的进钉间隙位于拇长展肌和拇短伸肌的近侧，其尺侧为拇长展肌和指伸肌腱，桡侧为桡侧腕短伸肌，此间隙最远端距Lister结节距离为（63．69±3．00）mm，最近端距Lister结节距离为（123．64±5．00）mm，克氏针做有限内固定的安全间隙为拇长伸肌腱和指伸肌腱、桡侧腕长短伸肌腱、拇短伸肌腱、伸肌支持带组成，该间隙近端距离Lister结节为（33．52±4．20）mm，远端距离Lister结节为（8．81±0．88）mm，在临床应用方面，腕关节的影像学恢复情况、功能评分情况差异无统计学意义（P〉0．05）。而两组术后并发症的发生差异有统计学意义（P〈0．05）。结论根据对桡骨远端骨折的解剖学研究，并将研究结果应用于外固定架治疗桡骨远端骨折的操作中，使其具有操作简单、复位好，固定牢靠、创伤小等优点，值得在临床广泛推广。

Clinical and anatomy research external fixation combined with limited cut restoration gram needle internal fixation for distal radial fractures

Objective To explore the anatomy and clinical significance of fixation combined with limited outside cut restoration gram needle internal fixation for distal radial fractures. Methods Based on the anatomical observation and measurement of the forearm and hand. Found out the distal radial fractures fixed bracket screws and gram needle safety area and the needle into the body, and made reasonable angle respectively, to formulate standardized orientation, and applied to clinical procedures, and the clinical cases were followed up. The clinical curative effect was observed. Results The place for the fixed bracket screws of the second metacarpal was the nail parts of radial dorsal partial ends. The proximal fracture for external fixation stents bolt into the nail near abductor muscle and manipulation long in the thumb short extensormuscles. Its feet side for stabbing abductor muscle and refers to a long stretch of radial side for tendon, radial side wrist short stretch muscles. The farthest distance between the lister nodule was (63.69 ±3.00) mm,nearest distance between the lister nodule was(123.64 ±5.00)mm. Gram needle do limited internal fixation security clearance for thumb long stretch tendon and refers to stretch tendons,radial side wrist length stretch tendons, thumb short extensor tendons, stretch retinaculum and this gap proximal distance lister nodule for ( 33. 52 ± 4.20) mm, remote distance lister nodule for( 8.81 ± 0. 88) mm. In clinical applications, wrist imaging recovery, function of ratings had no significant difference ( P ＞ 0.05). But the postoperative complications of the two sets of patients had statistically significant difference ( P ＜ 0. 05 ). Conclusion According to the anatomy of distal radial fractures,from the results of our research applied in fixation distal radial fractures in the operation,it had the advantages of simple operation,reset good,fixed firmly,and small trauma. It was worth of used widely in clinical.