伸肌支持带成形在桡骨远端骨折背侧钢板固定中的应用  

The application of extensor retinaculum flap in the treatment of distal radius fracture with locldng plate fixation through a dorsal approach

作　　者：卓高豹[1] 温新[1] 徐灵凤 张怀保[1] 倪晓[1] 杜胜虎 金永龙[1] 邱海胜[1] 王健[1] Zhuo Gaobao Wen Xin Xu Lingfeng Zhang Huaibao Ni Xiao Du Shenghu Jin Yonglong Qiu Haisheng Wang Jian.(Department of Hand Surgery and Peripheral Nerve Surgery, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, Chin)

机构地区：[1]温州医科大学附属第一医院手外科,325000

出　　处：《中华手外科杂志》2017年第4期286-288,共3页Chinese Journal of Hand Surgery

基　　金：温州市科学技术局公益性科技计划项目（Y20160375）

摘　　要：目的探讨“Z”形伸肌支持带成形、伸肌腱浅置在桡骨远端骨折背侧钢板固定中的应用及疗效。方法自2012年12月至2015年3月，我们采用“Z”形伸肌支持带成形、伸肌腱浅置、锁定钢板内固定治疗桡骨远端粉碎移位骨折患者23例，其中单纯背侧钢板18例，掌侧＋背侧钢板5例。术中用“Z”形切开的伸肌支持带成形后分隔肌腱钢板，并将第3,4或第2,3，4伸肌间室肌腱浅置。随访术前术后腕关节影像学指标、患腕患指活动度、握力、Gartland～Werley评分、DASH评分以及肌腱断裂等并发症。结果术后随访时间为7-34个月，平均14．4个月。腕关节影像学指标均较术前改善，患腕患指活动度恢复良好，Gartland—Werley评分优良率为73．9％，DASH评分为18．3，无肌腱断裂、弓弦畸形等并发症发生。结论桡骨远端背侧钢板固定后，“Z”形伸肌支持带成形覆盖钢板并肌腱浅置，有利于避免肌腱激惹、断裂，不会造成弓弦畸形及伸腕伸指角度丢失，是治疗该类骨折的有效方法。Objective To investigate the application and clinical outcomes of Z-shaped extensor retinaculum flap and extensor tendons superficial position in the treatment of distal radius fracture with locking plate fixation through a dorsal approach. Methods From December 2012 to March 2015, 23 cases of comminuted distal radius fractures were surgically treated by locking plate fixation, Z-shaped extensor retinaculum flap and extensor tendons superficial position. Dorsal locking plate was used in 18 cases, while dorsal and volar locking plate were used in 5 cases. The retinaculum was cut ha a Z-shaped way and sutured to separate the extensor tendon from plate. The 3rd/4th or 2nd/3rd/4th compartment extensor tendons were placed above the flap. Follow-up evaluations included wrist radiography parameters before and after the surgery, wrist and finger range of active motion, grip strength, Gartland-Werley scoring system, DASH score and complications such as tendon rapture. Results Postoperative follow-up ranged from 7 to 34 months with an average of 14.4 months. Wrist radiography parameters after the surgery were significantly better than that before the surgery （P〈0.05）. Wrist and finger range of active motion were good according to Gartland-Werley scoring system, the overall satisfactory rate was 73.9%. DASH score was 18.3. No tendon rupture and bowstring deformity occurred. Conclusion After dorsal plate fixation, the application of Z-shaped extensor retinaculum flap to cover plate combined with extensor tendons superficial position can prevent tendon irritation or rupture, which will not cause the loss of wrist and finger range of motion or bowstring deformity. It was an effective method for the treatment of comminuted distal radius fractures.

关 键 词：桡骨骨折 骨折固定术 内 背侧入路 伸肌支持带 

分 类 号：R687.3[医药卫生—骨科学]