可调式锁定接骨板治疗桡骨远端骨折畸形愈合  

Malunion in distal radius fracture： reconstruction with a special palmar fixed-angle plate

作　　者：瞿玉兴[1] 蒋涛[1] 赵洪[1] 高益[1] 侯为林[1] 郑冲[1] 王斌[1] 徐建达[1] 

机构地区：[1]江苏省常州市中医医院骨科,常州213003

出　　处：《中华骨科杂志》2014年第7期717-722,共6页Chinese Journal of Orthopaedics

摘　　要：目的 探讨可调式锁定接骨板治疗桡骨远端骨折畸形愈合的临床疗效.方法 回顾性分析2010年5月至2012年3月,采用可调式锁定接骨板治疗11例骨折畸形愈合患者资料,男3例,女8例;年龄35 ～ 76岁,平均（62.5±12.3）岁;左侧4例,右侧7例.其中2例为夹板固定治疗后致畸形愈合,2例为石膏固定治疗后致畸形愈合,1例为外固定治疗后致畸形愈合,6例为切开复位钢板内固定治疗后致畸形愈合;初次手术至再手术时间为5～20个月,平均（13.9±5.6）个月.根据影像学（包括尺骨变异、掌倾角、尺偏角）表现及握力、腕关节关节活动度、疼痛视觉模拟评分（visual analogue scale,VAS）、上肢功能（disability of arm shoulder and hand,DASH）调查表评价术后疗效.结果 11例患者均获得完整随访,随访时间10 ～ 15个月,平均12个月;影像学骨折愈合时间为7～12周,平均8周.术后12个月腕关节屈曲活动度为50.2°±11.3°（范围,35°～70°）,背伸为55.1°±11.5°（范围,30°～80°）,尺偏为30.1°±9.2°（范围,10°～40°）,桡偏为22.1°±6.6°（范围,10°～ 30°）,旋前为79.9°±8.5°（范围,60°～90°）,旋后为82.6°±11.2°（范围,50°～90°）;术后12个月DASH评分为平均（18.5±8.3）分（范围,10～35分）,较术前平均（52.7±11.3）分有明显改善;术后VAS评分为平均（1.7±1.2）分（范围,0～4分）,较术前平均（5.9±1.4）分明显改善.2例患者术后腕关节功能轻度受限,其中l例患者在重体力工作时有中度疼痛,但在内固定取出后症状改善;另1例患者经消炎镇痛药物治疗后症状改善.无一例发生继发移位、内置物松动及软组织感染.结论 可调式锁定接骨板作为一种全新的钢板可以用于治疗桡骨远端骨折畸形愈合,术后患者腕关节解剖结构得以重建,关节功能获得改善.Objective To detective the clinical effect of a special palmar fixed-angle plate on malunion in distal radius fracture.Methods We reviewed retrospectively 11 patients withmalunions in distal radius fracture who admitted to the hospital from May 2010 to March 2012.Among them,there were 3 males and 8 females,with an average age of 62.5±12.3 years old （range,35-76 years old）.According to the treatment,2 got splintage,2 got plaster fixation,1 got external fixation and 6 got internal fixation.The time from initial fixation to the osteotomy was 5-20 months （average 13.9±5.6 months）.During last follow-up,radiological results （radial length,ulna variance） and functional results （range of movement,and grip strength,VAS scores,DASH scores） were assessed.Results After patients got followed up of 12 months and recovered,the radiological and functional results improved with no secondary displacement,and no superficial or deep infection.All fractures united radiologically about 8 （range,7-12） weeks with low pain scores,good wrist function and grip strength.At the last follow-up （12 month）,the excellent average motion was extension 55.1°± 11.5° （range,30°-80°）,flexion 50.2°± 11.3° （range,35°-70°）,supination 82.6°± 11.2° （range,50°-90°） and pronation 79.9°±8.5° （range,60°-90°）.Of the 2 patients with low functional restriction,one patient had mild pain during heavy work and improved after the plate was removed,and the other one got better after the use of anti-inflammatory analgesic drugs.The DASH disability/symptom score and VAS score averaged 18.5±8.3 （range,10-35）and 1.7±1.2 （range,0-4） in our series,represent high levels of satisfaction.Conclusion The new special palmar fixed-angle plate was preferred for malunion in distal radius fractures to reconstruct the articular anatomy and improve the function of the wrist.

关 键 词：桡骨骨折 内固定器 骨折固定术 内 治疗结果 

分 类 号：R687.3[医药卫生—骨科学]