桡骨远端骨折畸形愈合合并远尺桡关节脱位的治疗

目的：探讨桡骨远端截骨矫形、尺侧腕屈肌腱移位、腕背侧关节囊及伸肌支持带紧缩重建远尺桡关节治疗桡骨远端骨折畸形愈合合并远尺桡关节脱位的临床疗效。方法：21例桡骨远端骨折畸形愈合合并远尺桡关节脱位。骨折类型按AO桡骨远端骨折分类皆为A型,未合并远尺桡关节炎。行桡骨远端截骨后,在＂C＂形臂下,桡骨高、掌倾角、尺偏角、远尺桡关节面对位恢复正常解剖位置,重建钢板固定,自体髂骨植骨。尺侧腕屈肌腱移位,腕背侧关节囊及伸肌支持带紧缩重建远尺桡关节。部分患者行旋前方肌松解。前臂旋后位克氏针固定。结果：21例患者均获随访,时间15～24个月,平均19.3个月。术前前臂旋转活动度为（41.6±8.9）°,术后为（138.1±14.3）°; 腕关节背伸术前为（9.2±4.2）°,术后为（33.2±11.8）°; 腕关节尺偏活动度术前为（10.5±6.3）°,术后为（31.3±4.4）°。Mayo评分结果：优10例,良7例,可4例。结论：应用桡骨远端截骨矫形术治疗尺侧腕屈肌腱移位,腕背侧关节囊及伸肌支持带紧缩重建远尺桡关节治疗桡骨远端骨折畸形愈合合并远尺桡关节脱位,手术效果良好,安全可靠。前臂旋转功能及腕关节各项运动功能得到有效恢复。

Treatment of malunion of distal radius fractures combined with dislocation of distal radioulnar joint

Objective：To explore the outcome of osteotomy and orthopedic of distal radius fractures,the reconstruction of distal radioulnar joint （DRUJ） with transposition of flexor carpi ulnaris （FCU）,tightening dorsal carpal ligaments and exten sor retinaculums for treatment of malunions of distal radius fractures combined with dislocation of DRUJ.Methods：21 patients of malunion of distal radius fractures combined with dislocation of DRUJ were performed operations.According to the AO classification,all fractures were classified as type A.All patients did not suffer from arthritis of DRUJ.The radius osteotomy and anatomical reduction were performed under C-arm to restore the radius height,palmar tilt angle,ulna incli nation angle,correlation between articular surfaces of DRUJ.The osteotomized radius were fixed with reconstruction plates.The auto-grafting from the iliac bones were applied.DRUJs were reconstructed with transposition of FCU and tightening dorsal carpal ligaments and extensor retinaculums.The forearms of supination were fixed with the K-wires.Pronator quadra tus were released with part of the patients.Results：21 patients were followed up for 15-24 months,an average of 19.3 months.The range of motion of forearm rotation was （41.6±8.9）° preoperatively and （138.1±14.3）° postoperatively,carpal dorsal extension was （9.2±4.2）° preoperatively and （33.2±11.8）° postoperatively,carpal ulnar deviation was （10.5±6.3）° preopera tively and （31.3±4.4）° postoperatively.According to Mayo grade,10 were evaluated as excellent,7 as good,4 as fair.Conclusion：The osteotomy and orthopedic of distal radius,the reconstruction of DRUJ with transposition of FCU and tightening carpal dorsal ligament and extensor retonaculum is a reliable,safe and effective treatment method for malunion of distal ra dius fractures combined with dislocation of DRUJ.Forearm rotation and wrist movement function are well recovered.