外固定支架联合Kapandji技术微创治疗老年桡骨远端不稳定骨折

目的探讨外固定支架联合Kapandji技术治疗老年桡骨远端不稳定骨折的疗效。方法2012年5月~2016年2月对21例老年桡骨远端不稳定骨折(按AO分型:A3型6例,B2型3例,C2型9例,C3型3例)采用外固定支架联合克氏针经皮插入以阻挡骨块再移位的Kapandji技术。末次随访根据改良的Sarmiento评分进行影像学评估,根据Gartland-Werley功能评分标准进行腕关节功能评估。结果手术时间25~45 min,平均35.3 min。术后住院时间3~14 d,平均6.5 d。21例随访8~24个月,平均15.3月,骨折均获愈合。影像学评分:优17例,良4例;腕关节功能评分:优13例,良5例,可3例,优良率为85.7%(18/21)。结论外固定支架联合Kapandji技术是老年桡骨远端不稳定骨折有效的微创手术方法,易于操作,避免伸肌腱的刺激,可有效增强固定的稳定性,功能恢复良好。

External Fixator Combined With Kapandji Technique for Treatment of Unstable Distal Radius Fractures in Elderly Patients

Objective To explore the effect of external fixator combined with Kapandji technique for treatment of unstable distal radius fractures in elderly patients.Methods A retrospective study was made on 21 elderly patients with unstable distal radius fracture from May 2012 to February 2016.All the patients were treated with external fixator combined with Kapandji technique by using percutaneous insertion of Kirschner wire to prevent fracture displacement.According to the AO classification,there were 6 cases of type A3,3 cases of type B2,9 cases of type C2,and 3 cases of type C3.The radiographic parameters were evaluated according to the modified Sarmiento scale at the last follow-up.Wrist function was assessed by using Gartland-Werley scoring system.Results The operation time ranged 25-45 min,with an average of 35.3 min.The postoperative hospital stay ranged 3-14 d,with an average of 6.5 d.All the 21 patients were successfully followed up for 8-24 months,with an average of 15.3 months.All the patients had a complete healing of their fractures.The radiographic manifestation was rated as excellent in 17 patients and good in 4.The Garland-Werley functional assessment rated wrist function to be excellent in 13 patients,good in 5 and fair in 3.Conclusion External fixator combined with Kapandji technique is an effective method for unstable distal radius fractures in elderly patients,which avoids the stimulation of extensor tendon with enough fixtion and obtains good clinical results.