锁定加压接骨板治疗不稳定型桡骨远端粉碎性骨折

目的探讨不稳定型桡骨远端粉碎性骨折的治疗方法及效果。方法2007年2月-2011年1月根据桡骨远端骨折的类型分别采用掌侧入路、背侧入路及桡侧缘入路行切开复位加压锁定接骨板内固定或加植骨治疗不稳定型桡骨远端粉碎性骨折46例59侧，按照AO分型A2型4侧，A3型7侧，B1型3侧，B2型5侧，B3型10侧，C1型8侧，C2型13侧，C3型9侧。术中行植骨17侧。结果46例患者中41例49侧获5～28个月随访（平均14个月），全部骨性愈合。腕关节功能按照改良McBride评分标准，优34侧，腕关节背伸750，掌曲-75°；良12侧，背伸70°，掌曲-54°；可3侧，腕关节屈伸有轻微痛，优良率92％。并发症包括背侧入路形成腱鞘炎4例，掌侧入路并发腕管综合征1例，均于拆除内固定后消失。结论复杂的不稳定型桡骨远端粉碎性骨折根据不同骨折类型采用不同的手术入路及支撑板内固定治疗可获得良好的腕关节功能恢复。

Clinical study on instable comminuted fracture of distal radius treated by Locking Compression Plate (LCP)

Objective To explore the outcome of instable comminuted fracture of distal radius treated by locking compression plate. Methods There were 46 cases of 52 sides with instable comminuted fracture of the distal radius, from Feb 2007 to Aug 2010, according to AO classification, of which A2 was 4 sides, A3-type 7 side, Bl-type 3 sides, B2-type 5 sides, B3-type 10 sides, Cl-type 8 sides, C2-type 13 sides, and C3-type 9 side. All of those were taken the open reduction and internal fixation with locking plate pressure by volar appraoch, dorsal margin of approach and the radial side, respectively, of which there were 17 sides were taken intraoperative graft. Results There were 41 patients with 50 sides followed up, who were all healed and whose follow-up time was 5-28 months （mean 14 months）.There were 34 sides excellent with wrist joint 75°（dorsiflexion） -75°（palm flexion）, 12 sides good with 70 ° （dorsiflexion） -54° （palm flexion）, 3 side may with shght pain, whose good rate was 92% according to criteria modified Mc Bride. Comphcations included 4 cases with the formation of dorsal tenosynovitis, 1 case with concurrent volar carpal tunnel, but the above 5 complictions were disappeared after the removal of internal fixation. Conclusion The outcome of complex instabihty of comminuted fractures of distal radius fractures treated by locking compression plate is good with functional recovery of the wrist, by different surgical approaches and different support plate fixation.