切开复位内固定治疗桡骨远端Die-punch骨折  

Open reduction and internal fixation for Die-punch fracture of distal radius

作　　者：徐林[1] 张咸中[1] 李黎明[1] 林国栋[1] 杨光诗[1] 李桂石[1] 

机构地区：[1]烟台毓璜顶医院手足外科,山东烟台264000

出　　处：《中国矫形外科杂志》2008年第14期1065-1067,共3页Orthopedic Journal of China

摘　　要：[目的]总结桡骨远端Die—punch骨折切开复位T型钛板内固定治疗的方法与疗效。[方法]2003年8月-2007年10月，收治29例根据X线片和／或CT确诊为Die—punch骨折（桡骨远端月骨关节面压缩骨折）的患者，男20例，女9例；年龄19～62岁，平均40．5岁；摔伤17例，坠落伤6例，交通伤4例，运动伤2例；开放伤6例；右侧18例．左侧11例；所有骨折关节面塌陷1．5～3．5mm；取掌侧切口，恢复关节面平整，关节面下骨缺损处取髂骨植骨，用T型钛板内固定。[结果]术后26例患者获得随访，时间9～45个月，平均27个月，均定期复查正侧位x线片，显示所有骨折均于12周内达临床愈合。根据X线片及腕关节ADL功能评定标准，优：38—40分，21例；良：35～37分，3例；可：32～34分，2例；差：〈32分．0例；优良率92．3％。无感染病例。[结论]切开复位内固定能较好地矫正关节面的塌陷，降低创伤性关节炎的发生率，是治疗桡骨远端Die—punch骨折的有效方法。[ Objective] To discuss the surgical technique and clinical effects of open reduction and internal fixation with T style plate in the treatment of Die -punch fracture of distal radius. [ Method] From August 2003 to October 2007, twenty-nine patients diagnosed as Die-punch fracture according to X-ray and computerized tomography were treated with open reduction through volar approach and internal fixation with T style plate and bone - grafts to support the articular surface of impacted fractures. There were 20 males and 9 females ,with an average of d0.5 years （ range 19 - 62 years）. The fractures were caused by falling （ n = 23 ） ,traffic （ n = d） and by athletics （ n = 2）. There were 6 cases of open fracture . Eighteen cases were in the right wrist, and 11 in the left wrist. The displacement of articulatzons was from 1.5 to 3.5 mm. [ Result] Twenty-six patients were followedup for 9 to 45 months,with an average of 28 months. Posteroanterior and lateral radiographs were taken periodically and fracture healing occurred all within 12 weeks. According to ADL standard and radiographs,21 cases were excellent（ADL scores：38 -40） ,3 cases were good（ scores ：35 - 37）. The excellent to good rate was 92.3%. No infection occurred. [ Conclusion] Open reduction and internal fixation can help restore the smoothness of the articular surface and reduce the incidence of traumatic osteoarthritis. It is effective against the Die - punch fractures of distal radius.

关 键 词：腕关节 桡骨远端骨折 切开复位内固定 治疗 

分 类 号：R687.3[医药卫生—骨科学]