Ⅰ期掌侧钢板内固定治疗Galeazzi骨折伴前臂骨筋膜室综合征临床疗效  

Clinical outcome of stage Ⅰ LCP internal fixation in the treatment of Galeazzi fracture associated with forearm compartment syndrome

作　　者：滕松松 王珮琳 马春辉[1] 俞银贤[1] 李立 易诚青[1] TENG Song-song,WANG Pei-lin,MA Chun-hui,YU Yin-xian,LI Li,YI Cheng-qing(Department of Orthopedic,Shanghai General Hospital,Shanghai 200080,Chin)

机构地区：[1]上海市第一人民医院骨科,上海200080 [2]海军军医大学附属长海医院关节骨病外科,上海200080

出　　处：《临床军医杂志》2018年第9期1014-1016,共3页Clinical Journal of Medical Officers

基　　金：国家自然科学基金(30700853);国家自然科学基金(81371979)

摘　　要：目的探讨行Ⅰ期掌侧锁定加压钢板内固定治疗Galeazzi骨折伴骨筋膜室综合征的临床效果。方法回顾性分析自2006年5月至2016年4月期间接受Ⅰ期手术治疗的8例Galeazzi骨折伴骨筋膜室综合征患者临床资料,手术方式均为早期行前臂筋膜切开减压术和骨折Ⅰ期掌侧钢板内固定术。记录患者神经血管恢复、并发症、骨折复位及愈合情况,并使用Gartland-Werly评分系统评估患者功能恢复情况。结果本组患者中,7例达到解剖复位,1例患者术后2周发现伴有5°掌侧成角的轻度移位,稳定性和复位形态维持在可接受水平,未被定为复位丢失。6例患者肌肉覆盖良好,2例患者通过局部肌瓣转移亦获得良好覆盖。7例皮肤移植创面愈合良好,1例中出现移植皮肤的部分坏死,因受影响区域非常小,且可与相邻存活皮肤融合,无需特殊处理。1例术后发生桡神经浅支损伤,随访6个月后不完全恢复。1例C2型骨折,骨折愈合延迟至6个月。根据Gartland-Werly评分系统,6例患者功能恢复良好,其中,1例发生复发性下尺桡关节脱位,但无明显功能障碍;2例患者出现关节僵硬。未发生缺血性肌挛缩、骨不连。结论早期Ⅰ期掌侧锁定加压钢板内固定有利于Galeazzi骨折伴骨筋膜室综合征患者患肢充分减压、骨折断端稳定及功能恢复。Objective To investigate the clinical outcome of stage Ⅰ strategy for Galeazzi fractures accompanied by compartment syndrome using locking compression plate（LCP）fixation.Methods A retrospective study was performed on 8 cases of patients with Galeazzi fracture with forearm fascial compartment syndrome who were admitted from May 2006 to April 2016.Operation method for the early stage of forearm fascial incision decompression and bone fractures Ⅰ stage volar plate fixation.The patients′ neurovascular recovery,complications,fracture reduction and healing were recorded,and the patients′ functional recovery was assessed using the Gartland-Werly scoring system.Results Among this group of patients,7 cases reached anatomical reduction,2 weeks after surgery,1 case was with mild 5 ° volar angulation displacement,maintain stability and reset form at an acceptable level,which was not a reset lost.Muscle coverage was good in 6 cases,and good coverage was obtained in 2 cases with local muscle flap metastasis.The skin graft healed well in 7 cases,and partial necrosis of the transplanted skin appeared in 1 case,due to the affected area was very small and could be fused with adjacent surviving skin without special treatment.One case suffered from superficial branch of radial nerve injury after surgery,which was not completely recovered after 6 months of follow-up.In one case,the fracture healing was delayed to 6 months.According to the Gartland-werly score system,the function of 6 cases recovered well,among which 1 case had recurrent ulnar and radial dislocation without obvious dysfunction,2 cases had stiff joints,and no ischemic muscle contracture or nonunion occurred.Conclusion Early stage Ⅰ LCP internal fixation could be beneficial for sufficient decompression,fracture stabilization and functional recovery in the treatment of Galeazzi fracture associated with compartment syndrome.

关 键 词：GALEAZZI骨折 骨筋膜室综合征 筋膜切开减压术 内固定 

分 类 号：R683[医药卫生—骨科学]