1.5 cm掌侧微创入路锁定钢板内固定结合腕关节镜治疗复杂性桡骨远端骨折  

Application of locking plate internal fixation combined with wrist arthroscopy through 1.5 cm volar minimally invasive approach for the treatment of complex distal radius fractures

作　　者：刘军 韦旭明 刘浩 王鹏 薛源 芮永军 Liu Jun;Wei Xuming;Liu Hao;Wang Peng;Xue Yuan;Rui Yongjun(Department of Orthopedics,Wuxi Ninth People's Hospital,Wuxi 214062,China;Department of Orthopedics,Xinwu District Xinrui Hospital,Wuxi 214028,China)

机构地区：[1]无锡市第九人民医院创伤骨科,无锡214062 [2]无锡市新吴区新瑞医院骨科,无锡214028

出　　处：《中华手外科杂志》2025年第1期12-17,共6页Chinese Journal of Hand Surgery

基　　金：无锡市卫生健康委员会科技成果与适宜技术推广项目(T202147、T202156)。

摘　　要：目的:探讨1.5 cm掌侧微创入路锁定钢板内固定结合腕关节镜治疗复杂性桡骨远端骨折的疗效。方法:回顾性分析自2021年1月至2023年9月采用1.5 cm掌侧微创入路锁定钢板内固定结合腕关节镜治疗的15例复杂性桡骨远端骨折患者。AO分型B型7例,C型8例。通过手法复位、X线透视下骨折复位基本满意后以克氏针临时固定,经掌侧1.5 cm微创入路插入锁定钢板临时固定,然后行腕关节镜探查,软骨清理,辅助关节面骨折复位,再植入锁定螺钉固定,最后行关节镜下三角纤维软骨复合体尺侧缘撕裂修复1例、舟骨骨折固定1例、舟月关节不稳固定2例、软骨成形2例、尺骨茎突基底部骨折固定7例。术后随访内容包括腕关节活动度(range of motion,ROM)、握力、视觉模拟评分(visual analogue scale,VAS)、桡骨高度、掌倾角及尺偏角。腕关节功能采用Gartland-Werley腕关节评分和腕关节患者自行评估量表(patient-rated wrist evaluation,PRWE)评价。结果:术后切口均Ⅰ期愈合,无神经血管损伤和感染。术后所有患者均获得随访,时间为7~16个月,平均(12.0±2.5)个月,骨折均愈合,桡骨远端骨折愈合时间平均(7.8±1.4)周;腕骨间排列及桡尺远侧关节匹配良好。其中1例患者背侧1枚克氏针松动部分退出,于术后2.5个月取出,余内固定位置良好。末次随访,患侧桡骨高度、掌倾角和尺偏角与健侧相比,差异均无统计学意义(P>0.05);腕关节屈伸ROM、旋转ROM和握力分别达健侧94%、96%和95%,VAS为0.22±0.41,Gartland-Werley腕关节评分结果示腕关节功能优良率为93.33%,PRWE评分为18.5±2.61。结论:1.5 cm掌侧微创入路锁定钢板内固定结合腕关节镜治疗复杂性桡骨远端骨折,能微创诊治桡骨远端骨折及合并周围组织损伤,有效减少漏诊和并发症,治疗效果满意,是该类损伤较佳的治疗方法。Objective:To explore the clinical efficacy of locking plate internal fixation combined with wrist arthroscopy through 1.5 cm volar minimally invasive approach for the treatment of complex distal radius fractures.Methods:A retrospective analysis was conducted on 15 patients with complex distal radius fractures treated using locking plate internal fixation combined with wrist arthroscopy through 1.5 cm volar minimally invasive approach from January 2021 to September 2023.There were 7 cases of AO classification type B and 8 cases of type C.After satisfactory reduction of the fracture under manipulation reduction and X-ray fluoroscopy,temporary fixation with Kirschner wire was performed.A locking plate was inserted through a 1.5 cm minimally invasive approach on the volar side for temporary fixation.Then,wrist arthroscopy was performed to undertake cartilage clearance and assisted reduction of articular surface fractures.Locking screws were implanted for fixation.Finally,arthroscopic repair on 1 case of ulnar edge tear of the triangular fibrocartilage complex,scaphoid fracture fixation on 1 case,fixation of the unstable scaphoid joint on 2 cases,chondroplasty on 2 cases,and ulnar styloid process basal fracture fixation on 7 cases were performed.The wrist range of motion(ROM),grip strength,visual analogue scale(VAS),radius height,palm inclination angle and ulnar deviation were observed,and the wrist joint function was evaluated using the Gartland-Werley wrist joint score and the patient-rated wrist evaluation(PRWE)scale.Results:All postoperative incisions achieved primary healing without any neurovascular damage or infection.All patients were follow-up after surgery for 7 to 16 months,with an average of(12.0±2.5)months,and all fractures healed.The average healing time for distal radius fractures was(7.8±1.4)weeks.The arrangement between the wrist bones and the matching of the distal radioulnar joint were good.One of the patients had a loose Kirschner wire partially withdrawn from the back,which was removed 2.5 month

关 键 词：桡骨骨折 关节镜 外科手术 微创性 锁定钢板 

分 类 号：R687.3[医药卫生—骨科学]