背尺侧骨块累及月骨窝关节面1/8至1/3的AO分型C型桡骨远端骨折的内固定治疗  

Internal fixation treatment of AO-C type distal radius fractures accompanied with a dorsoulnar fragment involving 1/8 to 1/3 of the articular surface of the lunate facet

作　　者：季佳庆 张鑫[1] 钱继魁 吴晗 蔡涛 袁锋[1] 樊健[1] Ji Jiaqing;Zhang Xin;Qian Jikui;Wu Han;Cai Tao;Yuan Feng;Fan Jian(Department of Orthopaedics,Tongji Hospital Affiliated to Tongji University,Shanghai 200065,China)

机构地区：[1]同济大学附属同济医院骨科,上海200065

出　　处：《中华骨科杂志》2024年第2期87-95,共9页Chinese Journal of Orthopaedics

基　　金：上海市"创新行动计划"医学创新研究专项项目(20Y11912600);上海市同济医院重大疾病多中心临床研究项目(ITJ(ZD)2202)。

摘　　要：目的探讨内固定治疗背尺侧骨块累及月骨窝关节面1/8至1/3的AO分型C型桡骨远端骨折的临床疗效。方法回顾性分析2017年7月至2022年7月同济大学附属同济医院收治的背尺侧骨块累及月骨窝关节面1/8至1/3的C型桡骨远端骨患者55例,根据手术方式分为三组。掌侧钢板组(单纯采用掌侧锁定钢板治疗)22例,男11例、女11例,年龄(56.7±10.1)岁,C1型10例、C2型7例、C3型5例;掌侧钢板+背侧钢板组(采用掌侧锁定钢板联合背侧钢板治疗)15例,男6例、女9例,年龄(55.7±8.1)岁,C1型4例、C2型5例、C3型6例;掌侧钢板+背侧螺钉组(采用掌侧锁定钢板联合背侧螺钉治疗)18例,男8例、女10例,年龄(53.5±11.6)岁,C1型7例、C2型5例、C3型6例。比较三组患者手术时间、术后影像学指标、腕关节活动度、上肢功能障碍(disability of arm,shoulder and hand,DASH)评分、视觉模拟评分(visual analogue scale,VAS)以及并发症情况。结果所有患者手术均顺利完成,随访时间(14.9±2.2)个月(范围12~18个月);骨折均愈合,愈合时间为(12.4±2.3)周(范围9~16周)。掌侧钢板组、掌侧钢板+背侧钢板组、掌侧钢板+背侧螺钉组患者手术时间分别为(54.3±7.6)min、(70.7±5.9)min、(65.8±7.1)min,掌侧钢板组患者手术时间更少(F=27.04,P<0.001)。三组患者术后CT矢状面、冠状面、横断面背尺侧骨块残留移位距离分别为[(1.3±0.8)mm、(0.6±0.4)mm、(0.7±0.4)mm]、[(1.1±0.8)mm、(0.6±0.4)mm、(0.6±0.6)mm]、[(1.4±0.8)mm、(0.7±0.4)mm、(0.7±0.5)mm],掌背侧联合内固定两组的移位距离小于掌侧钢板组(P<0.05)。术后3个月三组患者腕关节掌屈活动度分别为44.2°±4.6°、47.7°±5.9°、48.8°±5.1°,背伸活动度分别为39.8°±6.2°、44.3°±4.6°、44.7°±5.1°,腕关节DASH评分分别为(23.0±4.2)分、(20.1±4.1)分、(19.4±3.0)分,VAS评分分别为(2.3±1.2)分、(1.6±1.3)分、(1.3±1.0)分。掌侧钢板+背侧钢板组患者腕关节掌屈和背伸�Objective To explore the clinical outcome of internal fixation in the treatment of AO C-type distal radius fracture accompanied with dorsoulnar fragment involving 1/8 to 1/3 of the articular surface of the lunate facet.Methods A total of 55 patients of AO C-type distal radius fracture accompanied with dorsoulnar fragment involving 1/8 to 1/3 of the articular surface of the lunate facet from July 2017 to July 2022 in Tongji Hospital Affiliated to Tongji University were retrospectively analyzed.In the volar plate group(volar locking plate treatment alone),there were 22 cases,11 males and 11 females,aged 56.7±10.1 years,10 C1 type,7 C2 type and 5 C3 type.There were 15 patients in the volar plate+dorsal plate group(treated with volar locking plate combined with dorsal plate),including 6 males and 9 females,aged 55.7±8.1 years old,4 C1 type,5 C2 type and 6 C3 type.In the volar plate+dorsal screw group(treated with volar locking plate combined with dorsal screw),there were 18 cases,8 males and 10 females,aged 53.5±11.6 years,7 cases of C1 type,5 cases of C2 type,and 6 cases of C3 type.The operation time,postoperative radiographic indicators,wrist range of motion(ROM),disability of arm,shoulder and hand(DASH)score,visual analogue scale(VAS)and postoperative complications were evaluated and compared between the three groups.Results All operations were successfully completed.Patients were followed up for 14.9±2.2 months(range,12-18 months),and the fracture healing time was 12.4±2.3 weeks(range,9-16 weeks).The operative time of patients in the volar plate group,volar plate+dorsal plate group and volar plate+dorsal screw group was 54.3±7.6 min,70.7±5.9 min and 65.8±7.1 min,respectively.Patients in the volar plate group had less operative time(F=27.04,P<0.001).The residual displacement of the dorsoulnar fragment in sagittal,coronal,and axial CT scans in the three groups were(1.3±0.8 mm,0.6±0.4 mm,0.7±0.4 mm),(1.1±0.8 mm,0.6±0.4 mm,0.6±0.6 mm),(1.4±0.8 mm,0.7±0.4 mm,0.7±0.5 mm).The displacement of the dorsoul

关 键 词：桡骨骨折 关节内骨折 骨折固定术 内 内固定器 

分 类 号：R687.3[医药卫生—骨科学]