腕关节镜联合硫酸钙骨水泥微创治疗C2和C3型桡骨远端关节内粉碎性骨折的效果  

Effect of Wrist Arthroscopy Combined with Calcium Sulfate Cement for Minimally Invasive Treatment of C2 and C3 Type Comminuted Intra-Articular Fractures of the Distal Radius

作　　者：窦邦现[1] 陶明振 DOU Bangxian;TAO Mingzhen(Department of Hand Surgery Ⅰ,Zhengzhou Orthopedic Hospital,Zhengzhou 450000,China)

机构地区：[1]郑州市骨科医院手外Ⅰ科,河南郑州450000

出　　处：《河南医学研究》2021年第22期4079-4082,共4页Henan Medical Research

基　　金：河南省科技攻关计划项目(LHGJ20191146)。

摘　　要：目的分析腕关节镜联合可吸收硫酸钙骨水泥微创治疗C2和C3型桡骨远端关节内粉碎性骨折的临床效果。方法选取2019年5月至2020年6月郑州市骨科医院收治的7例C2和C3型桡骨远端关节内粉碎性骨折患者,其中男2例,女5例,平均年龄(43.36±8.64)岁。术前根据影像学检查评估腕关节面损伤情况。术中首先于C臂辅助下简单手法复位,恢复腕关节大致正常解剖位置,然后于腕关节镜下进一步处理粉碎性骨折,恢复关节面平整。复位满意后透视引导下在骨折间隙内注入可吸收骨水泥。当骨折处理完成后,借助腕关节镜探查并修复三角纤维软骨复合体(TFCC)、舟月韧带等软组织损伤。术后1、3、6、12个月对患者进行门诊随访,评估术后Mayo腕关节功能评分、掌倾角、尺偏角、骨折愈合情况、骨水泥吸收情况及可能出现的并发症。结果患者均获得随访,时间为3~12个月,平均8.7个月。术后CT显示骨水泥少量渗漏1例。骨折愈合时间为8~14周,平均11.1周,骨水泥约4周以后逐渐被吸收,完全替代需12周以上。末次随访Mayo腕关节功能评分80~95分,平均88.6分,其中优4例,良3例。术后X线显示桡骨远端掌倾角9°~16°,平均13.1°,尺偏角15°~27°,平均20.4°。7例患者术后腕关节活动度良好,术后无感染、骨水泥排异、神经损伤、骨折不愈合、疼痛遗留等并发症。结论微创腕关节镜辅助下联合硫酸钙骨水泥治疗桡骨远端关节内C2、C3型骨折有效,对患者腕关节功能的恢复具有积极意义,但中远期术后疗效不明确,还需要进一步随访评估。Objective To analyze the clinical efficacy of wrist arthroscopy combined with absorbable calcium sulfate cement for minimally invasive treatment of C2 and C3 type comminuted intra-articular fractures of the distal radius.Methods From May 2019 to June 2020,7 cases of C2 and C3 type comminuted intra-articular fractures of the distal radius in the Zhengzhou Orthopedic Hospital were selected,including 2 males and 5 females with an average age of(43.36±8.64)years.Before operation,the wrist joint surface injury was evaluated according to the imaging examination.During the operation,the simple manual reduction was first assisted by the C arm to restore the approximate normal anatomical position of the wrist joint.Then,the comminuted fracture was further processed under the wrist arthroscopy to restore the flat joint surface.After satisfactory exploration,absorbable bone cement was injected into the fracture space under fluoroscopy guidance.After the fracture treatment was completed,the wrist arthroscopy was performed to explore and repair soft tissue injuries such as triangular fibrocartilage complex(TFCC)and scapho-lunar ligament.All patients were followed up in outpatient clinics at 1,3,6 and 12 months after surgery to evaluate the Mayo wrist function score,palm inclination,ulnar deflection,fracture healing,bone cement absorption and possible complications.Results All patients were followed up for 3 to 12 months,with an average of 8.7 months.Postoperative CT showed a small amount of bone cement leakage in 1 case.The healing time of fracture ranged from 8 to 14 weeks,with an average of 11.1 weeks.The bone cement was gradually absorbed after about 4 weeks,and it took more than 12 weeks to completely replace it.At the last follow-up,Mayo’s wrist function score ranged from 80 to 95 points,with an average score of 88.6 points,of which 4 cases were excellent and 3 cases were good.Postoperative X-ray showed that the metacarpal inclination angle of distal radius was 9°to 16°,with an average of 13.1°,and the ulnar deviat

关 键 词：桡骨远端骨折 关节镜 微创 硫酸钙 

分 类 号：R683.41[医药卫生—骨科学]