掌侧锁定接骨板治疗老年陈旧性桡骨远端骨折疗效观察  

Surgical techniques and effectiveness of volar locking plates for senile delayed distal radius fractures

作　　者：徐明剑 向富州 李春晓[1] 苏来提.肖合热提 盛加根[1] 

机构地区：[1]上海交通大学附属第六人民医院骨科,上海200233

出　　处：《中国修复重建外科杂志》2017年第7期785-789,共5页Chinese Journal of Reparative and Reconstructive Surgery

摘　　要：目的探讨解剖型桡骨远端掌侧锁定接骨板内固定治疗老年陈旧性桡骨远端骨折的手术复位固定技巧并评价其疗效。方法 2014年10月—2015年9月,采用解剖型桡骨远端掌侧锁定接骨板治疗25例老年陈旧性桡骨远端骨折。其中男3例,女22例;年龄65~87岁,平均73岁。致伤原因:摔伤19例,交通事故伤6例。均为闭合性骨折,按AO分型:A2型10例,A3型7例,B3型3例,C1型5例。其中18例因骨折不稳定行手法复位石膏固定,之后复位丢失行手术治疗;7例未接受任何治疗。病程33~126 d,平均61 d。术前掌倾角(–16.0±3.1)°,尺偏角(10.8±7.0)°,桡骨短缩(11.2±3.6)mm,腕关节屈曲活动度(41.0±7.5)°,腕关节背伸活动度(42.0±6.3)°,握力为健侧的33.0%±3.1%。结果术后患者切口均Ⅰ期愈合,无术后早期并发症发生。25例患者均获随访,随访时间1~1.5年,平均1.3年。X线片复查示所有患者骨折均顺利愈合,愈合时间为8~12周,平均9.2周;关节面移位均<1 mm。末次随访时桡骨远端掌倾角为(13.1±3.2)°,尺偏角为(21.9±4.6)°,桡骨短缩(2.0±1.1)mm,腕关节屈曲活动度为(52.0±11.7)°,腕关节背伸活动度为(65.0±4.8)°,握力为健侧的84.0%±4.2%,均较术前显著改善(P<0.05)。末次随访时采用Gartland和Werley评分评价疗效,优15例,良6例,可2例,差2例,优良率84%。结论利用解剖型桡骨远端掌侧锁定接骨板设计上的优势,辅以适当的手术技巧,能较好地复位固定老年陈旧性桡骨远端骨折,取得满意疗效。Objective To investigate the surgical technique and effectiveness ofvolar locking plates for senile delayed distal radius fractures. Methods Between October 2014 and September 2015, 25 cases of delayed distal radius fractures were treated by volar locking plates. There were 3 males and 22 females with an average age of 73 years （range, 65-87 years）. Injury was caused by tumble in 19 cases and by traffic accident in 6 cases. All the cases had closed fracture. According to the AO classification, 10 cases were rated as type A2, 7 cases as type A3, 3 cases as type B3, and 5 cases as type C1. The manual reduction and plaster immobilization were performed in 18 cases first, but reduction failed; no treatment was given in 7 cases before surgery. The time from injury to surgery was from 33 to 126 days （mean, 61 days）. Preoperatively, the volar tilting angle was （16.0±3.1）% the ulnar inclining angle was （10.8±7.0）°; the radial shortening was （11.2±3.6） ram; the wrist range of motion was （41.0±7.5）° in flexion and was （42.0±6.3）° in extension; and the grip strength was 33.0%±3.1% of normal side. Results All incisions healed primarily, and no postoperative complication occurred. The patients were followed up 1-1.5 years （mean, 1.3 years）. The X-ray films showed that fracture union was achieved in all the patients, with the mean healing time of 9.2 weeks （range, 8-12 weeks）; the displacement of the articular surface was less than 1 ram. At last follow-up, the volar tilting angle was （13.1±3.2）°; the ulnar inclining angle was （21.9±4.6）°; the radial shortening was （2.0± 1.1） mm; the wrist range of motion was （52.0± 11.7）°in flexion and was （65.0±4.8）° in extension; and the grip strength was 84.0%±4.2% of normal side; all showed significant difference when compared with preoperative ones （P〈0.05）. According to the Gartland and Werley score, the results were excellent in 15 cases, good in 6 cases, fair in 2 cases, and poor in 2 cases at last follow

关 键 词：陈旧性桡骨远端骨折 掌侧锁定接骨板 内固定 

分 类 号：R687.3[医药卫生—骨科学]