腕关节镜辅助钛内固定器治疗复杂性桡骨远端骨折  

Wrist arthroscopy-assisted titanium internal fixator for the treatment of complex distal radius fractures

作　　者：杨顺[1] 陈柯屹[1] 程亚博[1] 向往 张静[1] 古洪基 池昊天 Yang Shun;Chen Keyi;Cheng Yabo;Xiang Wang;Zhang Jing;Gu Hongji;Chi Haotian(Department of Trauma and Hand Surgery,SichuanProvincial Orthopedic Hospital (Chengdu Research Institute for Sports Injury,Chengdu Sports Hopspital),Chengdu 610041,SichuanProvince,China)

机构地区：[1]四川省骨科医院手腕科(成都体育医院,成都运动创伤研究所)

出　　处：《中国组织工程研究》2020年第3期366-371,共6页Chinese Journal of Tissue Engineering Research

基　　金：四川省科技厅课题(2017SZ0154),项目负责人:杨顺~~

摘　　要：背景:诊治传统复杂桡骨远端骨折中,未及时得到修复及临床漏诊并不少见,成为术后腕关节疼痛和功能障碍重要的原因。腕关节镜辅助下治疗复杂性桡骨远端骨折可以更加精准的判断复杂性桡骨远端骨折的损伤情况,而且镜下施行手术能保护血供,还可以一并修复关节内韧带、软骨损伤以及对腕骨脱位、骨折进行有效固定。目的:回顾性分析关节镜辅助下采用桡骨远端解剖锁定钢板治疗复杂性桡骨远端骨折的疗效。方法:2016年9月至2018年5月四川省骨科医院手腕科共收治了19例复杂性桡骨远端骨折患者,使用AO分型,其中B2型1例,B3型2例,C1型5例,C2型7例,C3型4例。所有患者对治疗方案均知情同意,且得到医院伦理委员会批准。均采用腕关节镜辅助下切开复位桡骨远端解剖锁定钢板内固定治疗,修复腕骨间韧带、三角纤维软骨复合体,并进行腕骨骨折固定等治疗。术后1年分别对比健侧与患侧的腕关节活动度、握力、桡骨高度、掌倾角及尺偏角,采用Mayo腕关节评分进行功能评定。结果与结论:①术后19例患者均获随访,桡骨远端骨折愈合时间为5-12个月,平均7个月;②术后1年,患侧腕关节活动度、握力、桡骨高度、掌倾角及尺偏角同健侧相比,差异均无显著性意义(P> 0.05);③根据Mayo腕关节评分评估疗效,优9例,良8例,可2例,优良率为90%;④提示关节镜辅助下采用桡骨远端解剖锁定钢板治疗复杂性桡骨远端骨折,能精准恢复关节稳定性,对骨折合并软骨损伤及关节内韧带同时修复,有利于早期功能锻炼,疗效满意。BACKGROUND: Traditional complex of diagnosis and treatment of distal radius fractures, did not get the repair in time and clinical misdiagnosis is not uncommon, become an important reason for the wrist joint pain and dysfunction. Wrist joint complexity assisted treatment of distal radius fractures can more accurately judge complexity of the distal radius fracture damage. The microscopic surgery can protect the blood supply, can also repair intra-articular ligament, cartilage injury, and along with all the dislocation, fracture of carpal bone fixed effectively. OBJECTIVE: To retrospectively analyze clinical effects of distal radial anatomical locking plate for complex distal radius fractures by joint arthroscopy. METHODS: Totally 19 patients with complex distal radius fractures, who were treated in the Department of Trauma and Hand Surgery, Sichuan Provincial Orthopedic Hospital from September 2016 to May 2018, were included in this study. According to AO classification, there were B2 type in 1 patient, B3 type in 2 patients, C1 type in 5 patients, C2 type in 7 patients and C3 type in 4 patients. All patients signed the informed consent. This study was approved by the Hospital Ethics Committee. Open reduction and internal fixation with anatomical locking plate of distal radius assisted by wrist arthroscopy were used to repair the intercarpal interosseous ligaments and triangular fibrocartilage complex, and to fix the wrist fracture. At 1 year after treatment, the range of wrist motion, grip strength, radial height, palm inclination angle and ulnar angle were compared with the healthy side, and the functional evaluation was conducted with Mayo wrist score. RESULTS AND CONCLUSION:(1) Nineteen patients received postoperative follow-up. The healing time of distal radius was 5-12 months, with an average of 7 months.(2) At 1 year after surgery, no significant difference was detected in the range of wrist motion, grip strength, radial height, palm inclination angle and ulnar angle(P > 0.05).(3) The Mayo wrist score was e

关 键 词：桡骨远端骨折 微创 关节镜 内固定器 腕关节 活动度 骨折愈合 

分 类 号：R459.9[医药卫生—治疗学] R318[医药卫生—临床医学]