桡骨Z形截骨延长治疗桡骨远端骨折畸形愈合的疗效分析  

Analysis of the curative effect of radial Z-shaped osteotomy lengthening for malunion of distal radial fracture

作　　者：李飞[1] 李璐兵[1] 帕尔哈提·瓦哈甫[1] 郑辉[1] 王雪[1] 方志远 王成伟[2] LI Fei;LI Lu-bing;PAERHATI Wahafu;ZHENG Hui;WANG Xue;FANG Zhi-Yuan;WANG Cheng-wei(Department of Orthopedic Surgery of Osteopathy,The Sixth Affiliated Hospital of Xinjiang Medical University,Urumqi,Xinjiang,830002,China)

机构地区：[1]新疆医科大学第六附属医院骨病矫形外科,乌鲁木齐830002 [2]新疆医科大学第三附属医院骨科,乌鲁木齐830000

出　　处：《中国骨与关节杂志》2022年第4期244-248,共5页Chinese Journal of Bone and Joint

摘　　要：目的探讨桡骨Z形截骨延长治疗桡骨远端骨折畸形愈合的方法及临床疗效。方法回顾性分析2013年1月至2020年1月,在我院行桡骨Z形截骨延长加锁定接骨板治疗桡骨远端骨折畸形愈合合并桡骨短缩的患者18例,并对其进行随访。观察指标包括术前术后腕关节活动度、腕关节功能及影像学评价,按Gartland-Werley功能评分标准对患者腕关节功能恢复情况进行评价。结果18例均获得随访,随访时间15~24个月,平均18个月。关节背伸活动度术前为(16.2±2.2)°,末次随访为(27.8±1.8)°;掌屈活动度术前为(19.2±2.9)°,末次随访为(46.1±3.5)°;前臂旋前活动度术前为(36.2±2.8)°,末次随访为(70.2±2.2)°;前臂旋后活动度术前为(17.2±2.4)°,末次随访为(40.2±3.4)°;差异均有统计学意义(P<0.05)。影像学检查示桡骨截骨处愈合可,下尺桡关节匹配度良好。Gartland-Werley腕关节功能评分方面,优14例,良3例,中1例,优良率94%。术后未出现切口感染、桡骨高度丢失、内固定失败及骨不连等并发症。结论桡骨Z形截骨延长治疗桡骨远端骨折畸形愈合合并下尺桡关节脱位,能明显改善腕关节功能,减少创伤性关节炎的发生,临床疗效满意。Objective To investigate the method and clinical effect of Z-shaped radial osteotomy and lengthening in the treatment of malunion of distal radius.Methods From January 2013 to January 2020,18 patients with malunion of distal radius fractures complicated with radial shortening were retrospectively analyzed and followed up.All underwent radial Z-shaped osteotomy lengthening and locking plate fixation in our hospital.Observation indexes included preoperative and postoperative wrist range of motion,wrist function and imaging evaluation.Wrist function recovery was evaluated according to Gartland-Werley function standard.Results All the 18 cases were followed up for 15-24 months,with an average of 18 months.The range of joint dorsiflexion activity was(16.2±2.2)°before operation and(27.8±1.8)°at the last follow-up;the range of palmar flexion activity was(19.2±2.9)°before operation and(46.1±3.5)°at the last follow-up;the range of forearm pronation activity was(36.2±2.8)°before operation and(70.2±2.2)°at the last follow-up;the range of forearm pronation activity was(17.2±2.4)°before operation and(40.2±3.4)°at the last follow-up;differences were statistically significant(P<0.05).Imaging examination showed that the radius osteotomy healed well and the lower radioulnar joint matched well.Gartland-Werley wrist function:excellent in 14 cases,good in 3 cases,fair in 1 case,excellent and good rate 94%.There were no complications such as incision infection,loss of radius height,internal fixation failure and nonunion.Conclusions Z-shaped osteotomy and lengthening of the radius can improve the function of wrist joint and reduce the incidence of traumatic arthritis.

关 键 词：桡骨骨折 骨折 连接错位 截骨术 

分 类 号：R683.4[医药卫生—骨科学]