掌侧入路锁定加压钢板内固定治疗老年桡骨远端骨质疏松性骨折

目的探讨T形锁定加压钢板治疗老年桡骨远端骨质疏松性骨折的初期疗效。方法总结2003年6月～2005年5月T形锁定加压钢板内固定治疗老年桡骨远端骨质疏松性骨折13例,男4例,女9例;年龄67～81岁,平均74岁。按AO分类标准:B2型2例,B3型3例,C1型2例,C2型5例,C3型1例,均为闭合性骨折。所有病例均采用掌侧入路,术中不显露背侧组织,骨缺损严重者置入人工骨(Osteoset)。术后功能康复时间6～30周,平均12.3周。术后第1天开始被动活动腕关节,1周后主动活动,功能锻炼。结果13例全部获得随访,平均13.2个月(4～22个月)。X线片显示骨折全部一期愈合,平均愈合时间为7周。所有病例均无感染、骨不连、钢板松动、腕管综合征、正中神经炎等并发症。按改良的Mcbride腕关节功能评价标准:优9例,良3例,可1例,优良率为92.3%。结论T形锁定加压钢板治疗老年骨质疏松引起的桡骨远端骨折,内固定牢靠,可以早期功能锻炼,减少了因长期固定而导致的骨量丢失,避免腕关节的僵硬程度,疗效佳。

Volar locking compression plate fixation for osteoporotic distal radius fractures in the elderly patients

Objective To evaluate the preliminary outcome of surgical treatment of unstable distal radius fractures caused by osteoporosis in the elderly patients with open reduction and internal fixation with T-shaped locking compression plates(T-LCP).Methods From June 2003 to may 2005,13 elderly cases of comminu ted unstable distal radius fractures caused by osteoporosis were treated with op en reduction and T-LCP internal fixation.They were four males and nine females,with an average age of 74 years old(ranging from 67 to 81).According to AO classification,two cases belonged to types B2,three to type B3,two to type C1,five to type C2 and one to type C3.All of them were closed fractures.They were fixated with T-LCP through the volar approach and their dorsal soft tissues were not dissected during the operation.Osteoset,the artificial bone substitute,was implanted in one case of large bone defect.The postoperative functional recovery ranged from 6 to 30 weeks with an average of 12.3 weeks.Passive wrist motion,active finger motion and forearm rotation were encouraged immediately after surgery.Active wrist motion was suggested seven days postoperatively.Result s The 13 cases were followed up for 4 to 22 months,with an average time of 13.2 months.The X-ray pictures showed that one-stage union was achieved in all the patients,with a mean healing time of seven weeks.No such complications were found as infection,non-union,loosing of nails,carpal tunnel syndrome or medium neuritis.Their clinical outcomes were evaluated according to the modified Mcbride grading system.Nine were rated as excellent,three as good and one as fair,with their good-excellent rate being 92.3%.Conclusions T-LCP can ensure a good fixation in the treatment of unstable distal radius fractures caused by osteoporosis in elderly patients,allow the patients to do early exercise,and achieve satisfactory clinical outcome.