掌侧斜T型锁定钢板排钉杠杆复位内固定治疗桡骨极远端骨折  

Effectiveness of volar oblique T-type locking plate and raft screws reduction and fixation in treatment of extreme distal radius fractures

作　　者：姚晓克[1] 伍玲娜 李建华[1] 黄文刚[1] 王崇文 顾祖超[1] 王跃[3] YAO Xiaoke;WU Lingna;LI Jianhua;HUANG Wengang;WANG Chongwen;GU Zuchao;WANG Yue(Department of Orthopedics,Chengdu First People’s Hospital,Chengdu Sichuan,610041,P.R.China;Intensive Care Unit,Chengdu First People’s Hospital,Chengdu Sichuan,610041,P.R.China;Department of Orthopedics,Sichuan Academy of Medical Science&Sichuan Provincial People’s Hospital,Chengdu Sichuan,610072,P.R.China)

机构地区：[1]成都市第一人民医院骨科,成都610041 [2]成都市第一人民医院重症医学科,成都610041 [3]四川省医学科学院·四川省人民医院骨科,成都610072

出　　处：《中国修复重建外科杂志》2020年第7期809-813,共5页Chinese Journal of Reparative and Reconstructive Surgery

基　　金：四川省卫生健康委员会科研课题(19PJ173)。

摘　　要：目的总结掌侧斜T型锁定钢板排钉杠杆复位内固定治疗桡骨极远端骨折的疗效。方法2014年7月—2018年7月,采用掌侧斜T型锁定钢板排钉杠杆复位内固定治疗15例桡骨极远端骨折患者。男6例,女9例;年龄30~66岁,平均56.6岁。致伤原因:高处坠落伤2例,摔伤13例。均为新鲜闭合性损伤。桡骨极远端骨折按国际内固定研究协会/美国骨创伤协会(AO/OTA)分型标准:23C1型8例,23C2型7例。合并尺骨茎突骨折7例,下尺桡关节不稳定2例。受伤至手术时间6~9 d,平均7.3 d。术后X线片复查骨折愈合情况及桡骨高度、掌倾角、尺偏角恢复情况,采用Cooney评分评估疗效。结果术后切口均Ⅰ期愈合。患者均获随访,随访时间12~24个月,平均14.6个月。X线片复查示骨折均达骨性愈合,愈合时间5~10个月,平均8.2个月;无内固定失效、骨折再移位等情况发生。末次随访时桡骨高度、掌倾角和尺偏角均较术前明显增加,差异有统计学意义(P<0.05)。Cooney评分中各项评分(疼痛、功能、活动度、握力)及总分均较术前明显提高,差异有统计学意义(P<0.05);获优11例、良3例、可1例,优良率达93%。结论掌侧斜T型锁定钢板排钉杠杆复位内固定可有效恢复桡骨高度、掌倾角、尺偏角,固定可靠,腕关节可及早活动,治疗桡骨极远端骨折可获得较好疗效。Objective To investigate the effectiveness of volar oblique T-type locking plate and raft screws reduction and fixation in the treatment of extreme distal radius fractures.Methods Between July 2014 and July 2018,15 patients with extreme distal radius fractures were treated with volar oblique T-type locking plate and raft screws reduction and fixation.There were 6 males and 9 females,aged from 30 to 66 years with an average age of 56.6 years.The cause of injury was falling from height in 2 cases and falling in 13 cases.All of them were fresh closed injuries.The fractures were rated as type 23C1 in 8 cases and as type 23C2 in 7 cases according to AO/Orthopaedic Trauma Association(AO/OTA)classification.There were 7 cases of ulnar styloid process fracture and 2 cases of distal radioulnar joint instability.The time from injury to operation was 6 to 9 days with an average of 7.3 days.The fracture healing and the radial height,palm inclination,and ulnar deviation were observed by X-ray reexamination.Cooney score was used to evaluate the effectiveness.Results All incisions healed by first intention.All patients were followed up 12-24 months,with an average of 14.6 months.X-ray films showed that all fractures healed,and the healing time ranged from 5 to 10 months,with an average of 8.2 months.No internal fixation failure or secondary fracture displacement occurred.At last follow-up,the radial height,palm inclination,and ulnar deviation recovered well,and the differences between pre-and postoperation were significant(P<0.05).The pain,function,activity,and grip strength scores and the total score of Cooney score were significantly higher than those before operation(P<0.05).There were 11 cases of excellent,3 cases of good,and1 case of good,with an excellent and good rate of 93%.Conclusion For extreme distal radius fractures,the volar oblique T-type locking plate and raft screws reduction and fixation can restore the radial height,palm inclination,and ulnar deviation,fix firmly,and recover the wrist joint function exercise ea

关 键 词：桡骨极远端骨折 斜T型锁定钢板 切开复位 内固定 

分 类 号：R687.3[医药卫生—骨科学]