程序化、微创化的四步法治疗桡骨极远端C型骨折  

Programmed and minimally invasive four-step treatment for C-type fractures of the distal radius

作　　者：王桂龙 李翠云[2] 刘加田 邱世超 韩舜 魏宝富[1] Wang Guilong;Li Cuiyun;Liu Jiatian;Qiu Shichao;Han Shun;Wei Baofu(Department of Hand and Foot Surgery,Linyi People's Hospital New District Hospital,Linyi 276003,China;Department of Pathology,Linyi People's Hospital New District Hospital,Linyi 276003,China)

机构地区：[1]临沂市人民医院新区医院手足外科,临沂276003 [2]临沂市人民医院新区医院病理科,临沂276003

出　　处：《中华手外科杂志》2024年第5期394-397,共4页Chinese Journal of Hand Surgery

摘　　要：目的 应用程序化、微创化的四步法治疗桡骨极远端C型骨折,探讨其临床疗效.方法 我院自2022年9月至2023年11月收治28例桡骨极远端C型骨折患者,骨折分型均为AO-C型.应用程序化、微创化的四步法进行治疗,第一步:闭合复位恢复桡骨远端高度及尺偏角;第二步:三角框架式克氏针固定桡骨远端桡侧及月骨窝掌侧骨折块;第三步:腕关节镜辅助调整背侧骨折块,恢复关节面平整,并探查有无舟月分离、TFCC损伤等合并伤,一并处理;第四步:功能位单边外固定架维持骨折稳定性.术后4周内积极手指伸屈功能锻炼,4周松开外固定架关节螺母开始腕关节屈伸、尺桡偏锻炼,6周去除外固定架,8~10周去除克氏针,加强腕关节功能锻炼.评估术后及术后1个月、3个月桡骨远端的尺偏角、桡骨茎突高度、掌倾角、泪滴角,术后半年采用Mayo腕关节评分对腕关节功能进行评估.结果 28例患者均随访6~12个月,平均10.3个月.所有患者均骨性愈合,桡骨远端解剖结构恢复良好,关节面均获得解剖复位,无神经、血管及肌腱损伤等并发症,无外固定架松动感染.有5例去除外固定架后出现部分克氏针松动,并有炎性反应,拔除后自愈.术后半年复查Mayo评分平均91.4分.结论 桡骨极远端C型骨折无掌侧钢板固定空间,我们采用的四步法,程序化、微创化进行治疗,取得了满意的临床疗效,是一种微创、有效的治疗方法.Objective e To investigate the clinical efficacy of programmed and minimally invasive four-step treatment for C-type fractures of the distal radius.Methods From September 2022 to November 2023,28 patients with distal radius type C fractures were treated in our hospital,all of whom were classified as AO-C fractures.The programmed and minimally invasive four-step treatment was adopted.The first step was to restore the height and ulnar deviation angle of the distal radius through closed reduction.The second step was to use a triangular frame Kirschner wire to fix the fracture fragments on the radial side of the distal radius and the palmar side of the lunate fossa.The third step was to use wrist arthroscopy to assist in adjusting the dorsal fracture fragment,restoring the joint surface to a flat state,and exploring for the presence of combined injuries such as separation of the scapula and TFCC,and treating them together.The fourth step was to maintain fracture stability with a functional unilateral external fixation frame.The function of finger extension and flexion was actively exercised within 4 weeks after surgery,the joint nut of the external fixation frame at 4 weeks was loosened to start wrist joint flexion and extension,ulnar radial deviation exercise,the external fixation frame was removed at 6 weeks,and Kirschner wires were removed at 8 to 10 weeks to strengthen wrist joint function exercise.The ulnar deviation angle,styloid height,palmar inclination angle,and tear drop angle of the distal radius were evaluated after surgery and at 1 and 3 months postoperatively.The wrist joint function was evaluated using the Mayo wrist joint score at 6 months postoperatively.Results All 28 patients were follow-up for 6 to 12 months,with an average of 10.3 months.All patients achieved bone healing,and the anatomical structure of the distal radius was well restored.The articular surfaces were all anatomically reduced,and there were no complications such as nerve,vascular,or tendon injuries.There were no cases of external f

关 键 词：桡骨骨折 治疗效果 程序化 微创 

分 类 号：R687.3[医药卫生—骨科学]