桡骨远端关节内骨折外固定器治疗的相关机制和原则探讨

目的 分析和探讨桡骨远端关节内骨折外固定器治疗的相关机制和原则.方法 笔者采用Orthofix外固定器和国产组合式外固定器治疗桡骨远端关节内骨折45例46肢,以齐藤英彦法对资料完整的37例38肢病例进行分型,分析其影像学表现、损伤和治疗相关机制以及特点.结果 各型复位方向和外固定腕关节位置均与致伤暴力方向相反.骨折愈合时间平均为43 d(37～62 d),平均随访时间14个月(3～56个月),按Dienst标准评估腕关节功能及疗效:优21例22肢,良10例10肢,可6例6肢.结论 闭合复位外固定能很好地解决桡骨远端关节内骨折的治疗问题,特别适用于粉碎型关节内骨折.其治疗原则是复位方向及腕关节外固定位置与损伤机制、移位情形相反,个别骨折块辅以切开复位时须强调有限切开,必须重视部分病例伴有的同侧桡骨中远段骨折和同侧尺骨远段骨折的处理.

Medlanism and Principle of External Fixator for Intra-articular Fracture of Distal Radius

Objective To investigate the mechanism and the principle of the treatment for intra-articular fracture of distal radius with the external fixation devices.Methods From March 2001 to August 2005,the Orthofix external fixators and national composite external fixation devices were used in the treatment of intra-articular fractures of distal radii in 46 limbs of 45 patients.According to Hidehiko Saito classification,37 patients(38 limbs) with complete data were classified into five types.The X-ray photos,the mechanism and characteristic in injury and treatment were analyzed in all patients.Results All fractures were united in 37 to 62 days after operations(mean 43 days).All patients were followed up for an average time of 14 months ranging from 3 to 56 months.According to Dienst grade,22 limbs were evaluated as excellent,10 as good,and 6 as fair.As a result of the analysis of the patients classified with Saito classification,the reduction and fixation for the fractures was in the reverse direction with the force of injury.Conclusion Treatment of intra-articular fracture of distal radius with closed reduction and external fixator can be completely satisfactorily.It is the treatment principle that the reduction and fixation in treatment for intra-articular fracture in distal radius must be in the reverse direction with the mechanism of injury and situation of deformity.Limited incision must be stressed when a few of bone blocks will be reduced in incised wound in some patients.We must pay more attention to the treatment of the fracture in middle to distal radius of same bone and the fracture in distal ulna of same limb.