新型撑开复位器在干骺端掌侧粉碎性桡骨远端骨折手术中的应用  

Preliminary application of a novel distraction reductor in the surgical treatment of unstable distal radius fractures with metaphyseal volar comminution

作　　者：夏胜利 乔美琦 马梓元 高峰 王彬 王少俊 孙泽毅 周小小[1] 易存国 苏日宝 金小广 王秀会[1] 陈叙含 Xia Shengli;Qiao Meiqi;Ma Ziyuan;Gao Feng;Wang Bin;Wang Shaojun;Sun Zeyi;Zhou Xiaoxiao;Yi Cunguo;Su Ribao;Jin Xiaoguang;Wang Xiuhui;Chen Xuhan(Department of Orthopaedics,Zhoupu Hospital Affiliated to Shanghai University of Medicine&Health Sciences,Shanghai 201318,China;Shanghai University of Traditional Chinese Medicine,Shanghai 201203,China;Department of Osteoarthrology,Shenzhen Hospital,Union Medical College,Huazhong University of Science and Technology,Shenzhen 518000,China;Zhoupu Community Health Service Center,Pudong New Area,Shanghai 201318,China)

机构地区：[1]上海健康医学院附属周浦医院骨科,上海201318 [2]上海中医药大学,上海201203 [3]华中科技大学协和深圳医院骨关节科,深圳518000 [4]上海市浦东新区周浦社区卫生服务中心,上海201318

出　　处：《中华创伤骨科杂志》2023年第8期663-669,共7页Chinese Journal of Orthopaedic Trauma

基　　金：上海市浦东新区卫生健康委员会领先人才培养计划资助项目(PWR12018-09);上海市浦东新区临床特色学科(PWYts2021-03);上海市浦东新区科技发展基金民生科研专项(PKJ2021-Y31);上海市卫生健康委员会卫生行业临床研究专项(202240112)。

摘　　要：目的探讨新型撑开复位器在伴有干骺端掌侧粉碎的不稳定型桡骨远端骨折手术治疗中的作用。方法回顾性分析自2019年1月至2020年12月上海健康医学院附属周浦医院骨科收治的27例伴有干骺端掌侧粉碎的不稳定型桡骨远端骨折患者资料。男6例,女21例;年龄(69.4±9.4)岁;均为单侧闭合性骨折;右侧17例,左侧10例。均行掌侧入路解剖型锁定钢板内固定治疗,术中采用新型撑开复位器进行骨折断端复位。术后定期影像学复查以评估骨折复位、维持及骨折愈合情况,术后1年评估腕关节活动度,利用上肢功能评分(DASH)、Gartland-Werley腕关节缺陷评分及Bartra放射学评分进行疗效评价。结果所有手术均顺利完成,手术时间(92.3±8.9)min,术后切口均一期愈合。所有患者术后获(15.9±2.9)个月随访。术后即刻桡骨高度、掌倾角、尺偏角、关节面台阶分别为(11.23±1.51)mm、12.10°±3.44°、20.54°±3.44°、(0.95±0.42)mm,术后1年以上桡骨远端解剖参数未见明显丢失,分别为(11.22±1.55)mm、12.07°±3.44°、20.51°±3.33°、(0.93±0.40)mm,以上项目术后即刻与术后1年比较差异无统计学意义(P>0.05)。术后1年腕关节背伸59.7°±5.5°,掌屈63.0°±9.1°,旋前66.5°±5.5°,旋后61.2°±5.6°,桡偏22.7°±4.8°,尺偏30.3°±6.1°;DASH评分为(13.5±5.5)分;Bartra评分为(88.6±6.5)分,优良率88.9%(24/27);Gartland-Werley缺陷评分为(2.7±2.1)分,优良率为92.6%(25/27)。随访未见骨折愈合不良、内固定失效、肌腱或神经损伤及创伤性关节炎的发生。结论在干骺端掌侧粉碎的不稳定型桡骨远端骨折手术治疗中,新型撑开复位器能有效纠正因掌侧皮质粉碎导致的短缩,获得满意的疗效。Objective To evaluate a novel distraction reductor in the surgical treatment of unstable distal radius fractures with metaphyseal volar comminution.Methods From January 2019 to December 2020,27 patients with unstable distal radius fracture complicated with metaphyseal volar comminution were treated at Department of Orthopaedics,Zhoupu Hospital Affiliated to Shanghai University of Medicine&Health Sciences.They were 6 males and 21 females,with an age of(69.4±9.4)years.All fractures were unilateral and closed,involving the right side in 17 cases and the left side in 10 cases.All patients were treated by internal fixation with an anatomical locking plate through the volar approach and the novel distraction reductor was used to reduce the fracture ends.Regular imaging examinations were performed to evaluate the reduction,maintenance and union of fractures after surgery.One year after operation,the curative efficacy was assessed by evaluation of the range of wrist motion,Disabilities of the Arm,Shoulder and Hand(DASH)score,Gartland-Werley score and Bartra radiology score.Results All the operations went on successfully with a duration of(92.3±8.9)min.All the incisions healed primarily.The follow-up time was(15.9±2.9)months.The radial height,palmar tilt,ulnar inclination and articular surface step-off immediately after operation[(11.23±1.51)mm,12.10°±3.44°,20.54°±3.44°,and(0.95±0.42)mm]were not significantly lost compared with those one year after operation[(11.22±1.55)mm,12.07°±3.44°,20.51°±3.33°,and(0.93±0.40)mm](all P>0.05).One year after operation,the range of wrist motion was good with dorsiflexion of 59.7°±5.5°,palm flexion of 63.0°±9.1°,pronation of 66.5°±5.5°,supination of 61.2°±5.6°,radial deviation of 22.7°±4.8°,and ulnar deviation of 30.3°±6.1°;DASH score was 13.5±5.5;Bartra radiology score was 88.6±6.5,giving an excellent and good rate of 88.9%(24/27);Gartland-Werley score was 2.7±2.1,giving an excellent and good rate of 92.6%(25/27).Follow-ups observed no poor fracture

关 键 词：桡骨骨折 桡腕关节 骨折固定术 内 新型撑开复位器 切开复位 

分 类 号：R687.3[医药卫生—骨科学]