锁定接骨板系统治疗桡骨远端骨折的临床疗效观察  

CLINICAL EFFECTS OF LOCKING PLATE SYSTEM IN TREATING DISTAL RADIAL FRACTURES

作　　者：周自广[1] 关日康 刘德荣 梁加利[3] 

机构地区：[1]北京市平谷区医院骨科,北京101200 [2]香港玛丽医院矫形及创伤外科 [3]香港大学医学院矫形及创伤外科学系

出　　处：《中国修复重建外科杂志》2009年第11期1294-1297,共4页Chinese Journal of Reparative and Reconstructive Surgery

摘　　要：目的探讨采用2.4mm带锁钢板固定系统治疗桡骨远端骨折的疗效。方法2004年5月-2006年11月,采用切开复位、2.4mm带锁钢板固定系统内固定治疗75例桡骨远端骨折。男41例,女34例;年龄13～82岁,平均51岁。左侧34例,右侧41例。损伤原因:摔伤49例,高处坠落伤14例,交通事故伤6例,运动伤6例。均为闭合性骨折。桡骨远端骨折根据Müller-AO分型:A型14例(18.7%),B型5例(6.7%),C型56例(74.6%)。受伤至手术时间5h～27d,平均6d。结果术后3、6个月,1、2年分别有75、71、68及51例患者获随访。术后73例切口Ⅰ期愈合,2例发生感染,换药后3、6周愈合。1例术中螺钉植于软骨下,术后第2天调整螺钉位置,术后1、3及6个月各1例复位失败,其中1例予石膏外固定,2例行再固定及自体髂骨植骨,末次随访时骨折均愈合;术后1d2例诉桡神经浅支分布区域皮肤麻木,口服营养神经药物后分别于术后5d和3个月症状消失,1例术后持续伤口疼痛,术后半年疼痛自行缓解;术后3、5d各1例发生肌腱感染,经保守治疗后3、6周治愈。末次随访时腕关节活动范围:旋前(80±9)°,旋后(86±7)°,背屈(57±10)°,掌屈(51±13)°,桡偏(18±7)°,尺偏(28±7)°。根据改良Green等评分标准,获优66例,良6例,差3例。末次随访时根据Knirk等标准,22例(29.3%)有1级骨性关节炎改变,5例(6.7%)有2级骨性关节炎改变,均为C型骨折患者。结论采用2.4mm带锁钢板固定系统治疗桡骨远端骨折,临床效果良好。Objective To determine the clinical results of locking plate system in the treatment of distal radial fractures. Methods From May 2004 to November 2006, 75 patients were treated with 2.4 rnm locking plate system. There were 41 males and 34 females, with a mean age of 51 years old （range, 13-82 years old）. The locations were left side in 34 cases and right side in 41 cases. The cause of injury was a low energy fall in 49 cases, falling from height in 14 cases, traffic accident in 6 cases and sports injuries in 6 cases. All patients were diagnosed as having closed fracture. According to Muller-AO classification, there were 14 cases（18.7%） of type A, 5 cases（6.7%） of type B, and 56 cases（74.6%） of type C. The time from injury to operation was 5 hours to 27 days （mean 6 days）. Results A total of 75 patients were followed up at 3 months, 71 patients at 6 months, 68 patients at 1 year and 51 patients at 2 years. Healing by first intention of incision was achieved in 73 cases, and infection occurred in 2 cases. Fracture reduction failed at 1 month, 3 months and 6 months in 1 case, respectively; 1 case received plaster fixation and 2 cases received re-fixation and autograft of ilium; and fracture healed in 3 cases at last follow-up. Two patients complained of skin numbness at site of superficial branch of radial nerve after 1 day, 1 patient had wound pain after operation, and 1 patient had infection of tendon at 3 days and 5 days in 1 case respectively. At last follow-up, the ranges of motion of wrist joint were （80 ± 9）° for pronation, （86 ± 7）° for supination, （57± 10）° for dorsal flexion, （51 ± 13）° for palmar flexion, （18 ± 7）° for radial inclination, and （28 ± 7）° for ulnar deviation. According to modified Green scoring, the results were excellent in 66 cases, good in 6 cases and poor in 3 cases. At last follow-up, according to Knirk criterion for osteoarthritis, there were 22 cases of grade I and 5 cases of grade II, and all were classified as type C. Conclusi

关 键 词：桡骨远端骨折 锁定接骨板系统 内固定 

分 类 号：R687.3[医药卫生—骨科学]