桡骨远端截骨矫形联合自体髂骨植骨治疗老年桡骨远端骨折畸形愈合疗效分析  

Analysis on efficacy of corrective osteotomy combined with autogenous iliac bone graft for malunited distal radius fractures in the elderly

作　　者：黄子阳 谢威 石诚 罗德庆[1] 丁罗兵 练克俭[1] 林达生[1] HUANG Ziyang;XIE Wei;SHI Cheng;LUO Deqing;DING Luobing;LIAN Kejian;LIN Dasheng(Orthopaedic Center of PLA,the 909th Hospital of the Joint Logistic Support Force(the Affiliated Southeast Hospital to Xiamen University),Zhangzhou,Fujian 363000,China)

机构地区：[1]联勤保障部队第九○九医院(厦门大学附属东南医院)全军骨科中心,福建漳州363000

出　　处：《中国骨与关节损伤杂志》2023年第3期262-266,共5页Chinese Journal of Bone and Joint Injury

基　　金：国家自然科学基金(82172477);福建省自然科学基金(2019J01144)。

摘　　要：目的 观察采用桡骨远端截骨矫形联合自体髂骨植骨治疗老年桡骨远端骨折畸形愈合的可行性与临床疗效。方法回顾性分析自2020-07—2021-12采用掌侧入路桡骨远端截骨矫形、锁定钢板内固定联合自体髂骨植骨治疗的22例老年桡骨远端骨折畸形愈合,比较术前与末次随访时腕关节影像学参数、腕关节活动度、患侧腕关节握力占健侧百分比、疼痛VAS评分,以及腕关节DASH评分、PRWE评分、Gartland-Werley评分。结果 22例均获得至少12个月随访,切口愈合良好,未出现感染、神经血管损伤。末次随访时X线片显示桡骨远端截骨矫形处骨痂生长良好,达到骨性愈合。截骨端骨性愈合时间为3~6个月,平均4.2个月。术前患侧腕关节握力占健侧百分比为(30.86±9.71)%,末次随访时恢复至健侧的(79.38±7.13)%,差异有统计学意义(P<0.05)。末次随访时腕关节疼痛VAS评分、DASH评分、PRWE评分、Gartland-Werley评分较术前明显改善,差异有统计学意义(P<0.05)。末次随访时腕关节影像学参数、腕关节活动度较术前明显改善,差异有统计学意义(P<0.05)。结论 桡骨远端截骨矫形联合自体髂骨植骨治疗老年桡骨远端骨折畸形愈合安全、有效,通过重建桡骨远端的解剖结构有效提升患者腕关节握力和腕关节活动度,有效改善患者临床症状,提高患者的生活质量。Objective To observe the clinical results and feasibility of corrective osteotomy combined with autogenous iliac bone graft for malunited distal radius fractures in the elderly.Methods A retrospective analysis on 22 cases of malunited dis-tal radius fractures in the elderly from July 2020 to December 2021 was conducted.All patients were treated with corrective os-teotomy combined with autogenous iliac bone graft and volar locking plate.Radiological parameters,range of motion of wrist.percentage of affected wrist grip strength in healthy side,VAS score,wrist DASH score,PRWE score and Garland-Werley score were compared between before operation and at last follow-up.Results Twenty-two elderly patients were successfully followed up for at least 12 months.The incisions of all patients healed well without infection and neurovascular injury.At the end of follow-up,X-rays of 22 patients showed fracture union was achieved.The time of fracture union was 3-6 months,with an average 4.2 months.That the percentage of the affected side's grip strength in the lateral side was(30.86±9.71)%preoperatively and(79.38±7.13)%at the last follow-up with statistically significant difference(P<0.05).There were significant differences in VAS score,DASH score,PRWE score,Gartland and Werley score,radiological parameters and range of motion wrist between before operation and at last follow-up(P<0.05).Conclusion Corrective osteotomy combined with autogenous iliac bone graft for malunited distal radius fractures in the elderly is safe and effective,and it can improve the grip strength and range of motion of wrist,and effectively relief patients'clinical symptoms and improve their quality of life by reconstructing anatomical of the distal radius.

关 键 词：桡骨远端骨折 骨折畸形愈合 截骨矫形 掌侧入路 植骨 内固定 

分 类 号：R687.3[医药卫生—骨科学]