桡骨远端不稳定骨折闭合复位外固定架克氏针固定  

Closed reduction and fixation with external fixator combined with Kirschner wire for unstable distal radius fractures

作　　者：庞涛[1] 陈纪宝[1] 郭燕芬[1] 孔庆华 宋其雨 PANG Tao;CHEN Ji-bao;GUO Yan-fen;KONG Qing-hua;SONG Qi-yu(Department of Orthopedics,Tai'an First People's Hospital,Tai'an 271000,China)

机构地区：[1]泰安市第一人民医院骨一科,山东泰安271000

出　　处：《中国矫形外科杂志》2024年第6期570-573,共4页Orthopedic Journal of China

摘　　要：[目的]评价闭合复位外固定架联合克氏针固定桡骨远端不稳定骨折的临床疗效。[方法]2019年3月—2021年9月,对30例桡骨远端不稳定骨折采用闭合复位外固定架联合克氏针固定,评价患者临床与影像资料。[结果]所有患者顺利手术,无严重并发症,手术时间(73.8±6.9)min,围手术期失血量(46.4±9.6)ml,外固定架去除时间(7.8±0.9)周。随术前、术后即刻和末次随访的时间推移,VAS评分显著减少[(8.1±0.6),(6.1±0.9),(3.3±0.3),P<0.001]。末次随访时Cooney评分,以及掌屈-背伸、桡偏-尺偏、旋前-旋后ROM显著改善(P<0.05)。影像方面,与术前比较,术后即刻和末次随访时掌倾角(volar tilt,VT)[(4.7±1.9)°,(13.2±0.7)°,(12.8±0.5)°,P<0.001]、尺偏角(radial inclination,RI)[(7.0±1.0)°,(22.8±0.8)°,(21.8±0.6)°,P<0.001]及桡骨茎突高度(radial styloid height,RH)[(5.8±1.0)mm,(11.4±0.6)mm,(9.2±0.5)mm,P<0.001]均显著增加,但与术后即刻相比,末次随访时时RH明显丢失(P<0.05)。[结论]对于不稳定型桡骨远端骨折,外固定架克氏针固定可获得较为满意的临床疗效,但也存在远期一定程度桡骨茎突高度丢失情况,可作为临床医生选择的手术方法之一。[Objective]To evaluate the clinical efficacy of closed reduction and fixation with external fixator combined with Kirschnerwire for unstable distal radius fractures.[Methods]From March 2019 to September 2021,a total of 30 patients received closed reductionand fixation with external fixator combined with Kirschner wire for unstable distal radius fractures,and the clinical and imaging data of thepatients were evaluated.[Results]All the patients were operated smoothly without serious complications,with operation time of(73.8±6.9)minutes,perioperative blood loss of(46.4±9.6)ml,and frame removal time of(7.8±0.9)weeks.With time from the point preoperatively,im-mediately postoperatively to that at the last follow-up,VAS score significantly reduced[(8.1±0.6),(6.1±0.9),(3.3±0.3),P<0.001].At the lastfollow-up,the Cooney score,palmar flexion-dorsal extension,radio-ulnar deviation,and pronation-supination ROMs were significantly im-proved(P<0.05).In term of imaging,compared with those preoperatively,the volar tilt(VT)[(4.7±1.9)°,(13.2±0.7)°,(12.8±0.5)°,P<0.001],radial inclination(RI)[(7.0±1.0)°,(22.8±0.8)°,(21.8±0.6)°,P<0.001]and radial styloid height(RH)[(5.8±1.0)mm,(11.4±0.6)mm,(9.2±0.5)mm,P<0.001]were significantly increased immediately postoperatively and at the latest follow up.However,the RH was significantlylost at the last follow-up compared with immediately after surgery(P<0.05).[Conclusion]For unstable distal radius fractures,closed reduc-tion and internal fixation with external fixator combined with Kirschner wire can obtain satisfactory clinical consequences,despite of loss ofradius styloid height in some extent latterly,which can be used as one of the surgical methods chosen by clinicians.

关 键 词：桡骨远端不稳定骨折 闭合复位 外固定架 克氏针 

分 类 号：R683.41[医药卫生—骨科学]