累及背侧关节面桡骨远端骨折的骨折线地图特征:螺钉有效固定治疗术后移位  

Fracture line map characteristics of distal radius fractures involving dorsal articular surface:effective fixation with screws for postoperative displacement

作　　者：胡流超 罗毅文 吴志方 Hu Liuchao;Luo Yiwen;Wu Zhifang(Third Affiliated Hospital,Guangzhou University of Chinese Medicine,Guangzhou 510378,Guangdong Province,China;Guangdong Research Institute for Orthopedics and Traumatology of Chinese Medicine,Guangzhou 510378,Guangdong Province,China)

机构地区：[1]广州中医药大学第三附属医院,广东省广州市510378 [2]广东省中医骨伤研究院,广东省广州市510378

出　　处：《中国组织工程研究》2025年第3期524-530,共7页Chinese Journal of Tissue Engineering Research

基　　金：基广东省中医药管理局科研项目(20231120),项目负责人:胡流超。

摘　　要：背景:掌侧锁定钢板固定是桡骨远端骨折临床上最常用的固定方式,但当骨折线累及背侧关节面时,掌侧钢板固定则存在术后背侧骨块移位风险,尤其是乙状切迹背侧骨块术后移位风险较高。目的:分析桡骨远端骨折累及背侧关节面的骨折线特点,进而深入研究累及乙状切迹背侧骨块发生术后移位的危险因素,为临床上提高复位成功率提供依据。方法:对2021年1月至2022年9月在广州中医药大学第三附属医院就诊的桡骨远端骨折患者进行回顾性分析。根据术前CT影像桡骨远端背侧骨折块数量1,2,3块及以上分别记为Ⅰ,Ⅱ,Ⅲ型骨折,分别绘制骨折线地图,分析其背侧骨折线形态特征。对存在乙状切迹背侧骨折的患者进行3个月以上随访,根据术后是否发生乙状切迹背侧骨块移位分为移位组和无移位组,比较两组患者年龄、性别、术前和术后CT解剖参数。结果与结论:①对AO/OTA分型C型累及背侧关节面145例患者进行骨折线地图分析,其中根据背侧骨折块数量:Ⅰ型25例(17.2%)、Ⅱ型82例(56.6%)、Ⅲ型38例(26.2%);骨折线地图显示Ⅰ型骨折块骨折线主要累及乙状切迹,Ⅱ型主要累及乙状切迹和lister结节,Ⅲ型则累及乙状切迹、lister结节和桡侧柱背侧。145例患者中86.2%(125/145例)累及乙状切迹,其中Ⅲ型累及比例高达94.7%(36/38例),Ⅱ型88.0%(72/82例),Ⅰ型68%(17/25例)。②76例AO/OTA分型C型累及乙状切迹背侧患者纳入进一步研究,其中术后未移位组65例,移位组11例;在单因素分析中,两组患者的年龄、性别、受伤部位、术前CT乙状切迹背侧骨块背侧边长(d1)、尺侧边长(d2)、乙状切迹背侧骨块背侧高度(d4)和钢板距桡骨尺侧边缘距离(d5)比较差异均无显著性意义(P>0.05);乙状切迹背侧骨块累及下尺桡关节占比[d2/(d2+d3)]、乙状切迹背侧骨块关节面占比(s1/s2)、尺侧螺钉尾端距背侧乙状切迹边缘的距离(d6)和乙�BACKGROUND:Palmar locking plate fixation is the most commonly used fixation method for distal radius fractures.However,when the fracture line involves the dorsal articular surface,palmar plate fixation carries a higher risk of postoperative displacement of the dorsal bone mass,especially the dorsal sigmoid notch bone mass.OBJECTIVE:To analyze the fracture line characteristics of distal radius fracture involving the dorsal articular surface,and further investigate the risk factors of postoperative displacement of the dorsal bone mass involving the sigmoid notch,so as to provide evidence for improving the success rate of surgery.METHODS:Retrospective analysis was performed on patients with distal radius fracture who were admitted to Third Affiliated Hospital of Guangzhou University of Chinese Medicine from January 2021 to September 2022.The number of dorsal fractures of the distal radius of 1,2,3 and above was divided into types I,II,and III based on preoperative CT images.The fracture line maps were drawn respectively to analyze the morphological characteristics of the dorsal fracture lines.Patients with dorsal sigmoid notch fracture were followed up for more than 3 months and divided into displaced group and non-displaced group according to whether the dorsal sigmoid notch bone mass displacement occurred after surgery.Age,sex,preoperative and postoperative CT anatomical parameters were compared between the two groups.RESULTS AND CONCLUSION:(1)145 patients with type C of AO/OTA involving the dorsal articular surface were analyzed by fracture line map.According to the number of dorsal fractures,there were 25 cases of type I fracture(17.2%),82 cases of type II fracture(56.6%),and 38 cases of type III fracture(26.2%).Fracture line map showed that the fracture line of type I fracture block mainly involved sigmoid notch;type II mainly involved sigmoid notch and lister tubercle,and type III involved sigmoid notch,lister tubercle,and dorsal radial column.Among the 145 patients,86.2%(125/145 cases)were involved in sigmoid

关 键 词：桡骨远端骨折 乙状切迹背侧骨块 掌侧钢板 内固定 骨折线 

分 类 号：R459.9[医药卫生—治疗学] R318[医药卫生—临床医学] R683