陈旧性桡骨远端骨折治疗20例  

Experience in the treatment of delayed distal radius fracture

作　　者：孙钰 顾加祥 张乃臣 张文忠 王天亮 袁超群 陆一鸣 刘宏君 SUN Yu;GU Jiaxiang;ZHANG Naichen(Department of Orthopedics,Subei People's Hospital,Jiangsu,yangzhou,225001,China)

机构地区：[1]苏北人民医院扬州大学临床医学院骨科,江苏扬州225001

出　　处：《实用手外科杂志》2021年第1期58-60,71,共4页Journal of Practical Hand Surgery

摘　　要：目的通过对20例陈旧性桡骨远端的治疗及术后功能评价总结陈旧性桡骨远端骨折的治疗方法。方法2017年1月-2018年10月,采用单侧或双侧切开复位内固定或内外固定加外固定治疗陈旧性桡骨远端骨折20例。均为闭合性骨折,按AO分型:A2型1例,A3型2例,B1型2例,C1型12例,C3型3例。所有患者均为手法复位不满意者。病程33~150 d,平均55 d。术前掌倾角(-18.0±4.1)°,尺偏角(14.8±7.0)°,桡骨短缩(14.2±3.6)mm,腕关节屈曲活动度(30.0±12.5)°,腕关节背伸活动度(35.0±5.5)°。腕关节旋前(65.0±10.0)°,旋后(65.0±15.0)°。结果术后患者切口均一期愈合,无术后早期并发症发生。全部患者均获随访,随访时间8~24个月,平均12个月。影像学检查示所有患者骨折均顺利愈合,愈合时间为8~14周,平均10周;末次随访时桡骨远端掌倾角为(12.1±4.1)°,尺偏角为(22.5±5.5)°,桡骨短缩(2.2±1.2)mm,腕关节屈曲活动度为(65.0±12.5)°,腕关节背伸活动度为(50.0±10.5)°。腕关节旋前(85.0±5.0)°,旋后(65.0±15.0)°,较术前均显著改善。末次随访时采用DASH基线评分,平均为14分。结论陈旧性桡骨远端骨折一旦有手术指征且患者要求改善目前不良症状的均应采取内固定辅以其他治疗方式,即内固定+外固定或两种不同的内固定方式,且绝大多数需植骨。Objective To summarize the treatment method of through the treatment and functional evaluation of 20 cases of delayed distal radius fracture. Methods From January 2017 to October 2018, 20 cases of delayed distal radius fractures were treated with unilateral or bilateral open reduction and internal fixation or internal fixation plus external fixation. Among the 20 patients, there were 3 males and 17 females, aged 55~75 years, with an average age of 62 years. The causes of injury were falls in 17 cases and traffic accidents in 3 cases. All of them were closed fractures. According to AO classification, there were 1 case of type A2, 2 cases of type A3, 2 cases of type B1, 12 cases of type C1 and 3 cases of type C3. All patients could not reach the standard of reduction by manual reduction. The course of disease ranged from 33 to 150 days, with an average of 55 days. Preoperative palmar inclination (-18.0±4.1) degree, ulnar deviation (14.8±7.0) degree, radius shortening (14.2±3.6) mm, wrist flexion activity (30.0±12.5) degree, wrist dorsal extension activity (35.0±5.5) degree. Results All incisions healed in the first stage after operation, and no early complications occurred. All patients were followed up for 8 to 24 months, with an average of 12 months. Imaging examination showed that all the fractures healed smoothly, the healing time was 8~14 weeks, with an average of 10 weeks. At the last follow-up, the distal radius palmar inclination angle was (12.1±4.1) degrees, the ulnar inclination angle was (22.5±5.5) degrees, the radius shortening was (2.2±1.2) mm, the wrist flexion activity was (65.0±12.5) degrees, and the wrist dorsal extension activity was (50.0±10.5) degrees. The wrist joint pronation (85.0±5.0) degree and supination (65.0±15.0) degree were significantly improved compared with those before operation. DASH baseline score was used at the last follow-up, with an average score of 14. Conclusion Once there are operative indications for delayed distal radius fractures and the patients need to imp

关 键 词：陈旧性桡骨远端骨折 切开复位 内固定 

分 类 号：R687.3[医药卫生—骨科学]