双微型锁定钢板经背侧入路治疗伴背侧移位桡骨远端C型骨折(附31例报告)  

Double mini-locking plate through dorsal approach in the treatment of type C fractures of distal radius with dorsal displacement

作　　者：蔡鸿儒[1,2,3,4] 许玮 张旭鸣[1,2,3,4] CAI Hong-ru;XU Wei;ZHANG Xu-ming(Department of EmergencySurgery,Fujian Provincial Hospital,Fuzhou 350001,China;Clinical Medical Collegeof Fujian Provincial Hospital,Fujian Medical University,Fuzhou 350001,China;FujianProvincial Emergency Center,Fuzhou 350001,China;Fujian Provincial Institute ofEmergency Medicine,Fuzhou 350001,China)

机构地区：[1]福建省立医院急诊外科,福州350001 [2]福建医科大学省立临床医学院,福州350001 [3]福建省急救中心,福州350001 [4]福建省急诊医学研究所,福州350001

出　　处：《创伤与急诊电子杂志》2018年第4期218-222,共5页Journal of Trauma and Emergency(Electronic Version)

摘　　要：目的探讨双微型锁定钢板经背侧入路治疗伴背侧移位桡骨远端C型骨折的近期临床疗效。方法选择2014年6月至2017年6月采用双微型锁定钢板经背侧入路治疗伴背侧移位桡骨远端C型骨折患者31例,其中男20例,女11例;年龄平均49岁(24～74岁)。骨折按AO分型:C1型9例,C2型20例,C3型2例。分别于术后第1周、1个月及6个月复查腕关节标准正侧位X线片,了解骨折愈合情况,于术前及术后6个月测量桡骨高度、掌倾角、尺偏角,腕关节功能参照Garland-Werley(GW)评价系统。结果 31例患者经术后随访8～28个月,平均13个月,所有患者均达到解剖复位,骨折愈合良好,8例行同种异体骨植骨。采用Gartland-Werley功能评估标准评定:优21例,良7例,可3例,优良率为90.32%。术前桡骨高度、掌倾角和尺偏角分别为(5.90±1.90)mm、(-5.29±2.66)°和(10.85±4.15)°,术后6个月分别为(11.32±1.90)mm、(12.00±2.67)°和(21.70±3.71)°,术后、术前差异均有统计学意义(P<0.05)。所有病例均未出现骨折内固定松动、骨不愈合、骨折移位、拇长伸肌腱炎、拇长伸肌腱断裂等并发症。结论双微型锁定钢板经背侧入路治疗伴背侧移位桡骨远端C型骨折,可使骨折端解剖复位,有效恢复腕关节的解剖结构及力学功能,取得理想临床疗效,是一种有效、可靠的手术方法。Objective To summarize the short-term clinical effect of the double mini-locking plate through dorsal approach in the treatment of type C fractures of distal radius with dorsal displacement. Methods Thirty-one patients (20 males and 11 females) with type C fractures of distal radius were treated by double mini-locking plate through dorsal approach from June 2014 to June 2017, with a mean age of 49 years (24-74 years). According to AO classification, there were 9 cases of type C1, 20 cases of type C2 and 2 cases of type C3. Allograft bone graft was performed on 8 cases. Standard anteroposterior radiographs of the wrist were reviewed at week 1, month 1 and month 6 after operation to observe the course of fracture healing. The height of radius, volar angle and ulnar angle were measured 6 months preoperatively and postoperatively. The function of the wrist was evaluated according to the Garland-Werley (GW) classification. Results Thirty-one cases were followed up for 8 to 28 months (mean 13 months). All the patients achieved anatomic reduction. According to the Gartland-Werley classification, 21 cases were excellent, 7 cases were good, and 3 cases were fair. The excellent and good rate was 90.32%. Radial height, volar inclination and ulnar declination 6 months after operation were (11.32±1.90) mm,(12.00±2.67)° and (21.70±3.71)°, respectively. It was statistically different from those[(5.90±1.90)mm,(-5.29±2.66)°,(10.85±4.15)°] before operation(P < 0.05). No complications such as loosening of internal fixation, nonunion of bone, displacement of fracture, tendonitis of extensor pollicis longus and rupture of tendon of extensor pollicis longus were found in all cases. Conclusion The treatment of type C fracture of distal radius with dorsal displacement with double mini-locking plate through dorsal approach can achieve fracture anatomic reduction, restore the anatomical structure and mechanical function of wrist joint effectively. It is effective and reliable.

关 键 词：桡骨远端骨折 双微型锁定钢板 背侧入路 

分 类 号：R687.3[医药卫生—骨科学]