两种不同内固定方法治疗背侧移位桡骨远端“C”型骨折疗效分析Analysis of two internal fixation methods for treatment of dorsally displaced type C fractures of the distal radius
周德杰;田军;徐军;刘财;
摘要(Abstract):
[目的]探讨掌侧"T"型锁定加压钢板和桡背侧双锁定加压钢板内固定方法治疗背侧移位桡骨远端"C"型骨折的临床疗效。[方法]回顾性分析本院2010年6月~2012年6月收治的桡骨远端"C"型骨折40例,采用掌侧"T"型锁定加压钢板内固定方法治疗20例,采用桡背侧双锁定加压钢板治疗20例,比较两种内固定方法的临床疗效。[结果]40例患者均获随访,随访时间6~18个月,平均12个月。腕关节功能按conney评分方法评价,放射学评价按改良Lidstrom-Radiographic标准评价。腕关节功能评价掌侧"T"型锁定加压钢板组优良率60%,桡背侧双锁定加压钢板组优良率90%,差异有统计学意义(P<0.05)。放射学评价掌侧"T"型锁定加压钢板组掌倾角(9.50±2.37)°,尺偏角(17.80±2.48)°,桡骨高度(9.50±2.83)mm,关节面台阶(2.00±1.30)mm;桡背侧双锁定加压钢板组掌倾角(11.05±2.06)°,尺偏角(20.10±2.34)°,桡骨高度(11.25±2.02)mm,关节面台阶(1.10±0.72)mm。两组掌倾角、尺偏角、关节面台阶、桡骨高度差异均有统计学意义(P<0.05)。两组术后并发症比较,术后早期并发症差异无统计学意义(P>0.05),术后远期并发症差异无统计学意义(P>0.05)。[结论]对于背侧移位桡骨远端"C"型骨折,桡背侧双锁定加压钢板内固定方法腕关节功能恢复优于掌侧"T"型锁定加压钢板内固定方法,桡背侧双锁定加压内固定术术后桡骨远端关节面恢复优于掌侧"T"型锁定加压钢板内固定。两种内固定方法早、远期并发症无明显差别。
关键词(KeyWords): 桡骨远端骨折;三柱理论;内固定
基金项目(Foundation):
作者(Author): 周德杰;田军;徐军;刘财;
Email:
DOI:
参考文献(References):
- [1]Hanel DP,Jones MD,Truemble TE.Wrist fracture[J].Orthop Clin North Am,2002,1:35-37.
- [2]Lutsk YK,Boyer MI,Stefen JA,et al.Arthmscopic assessment of intraarticular distal radius fractures after open reduction and intemal fixation from a volar approach[J].Hand Surg Am,2008,4:476-484.
- [3]蒋协远.骨科临床疗效评价标准[M].北京:人民卫生出版社,2005:52-58.
- [4]Van Eerten PV,Lindeboom R,Oosterkamp AE,et al.An X ray template assessment for distal radial fractures[J],Arch Trauma Surg,2008,2:217-221.
- [5]荣国威.骨科内固定学[M].3版.北京:人民卫生出版社,1995:330-332.
- [6]孙建峰,顾敏琪,邓磊,等.桡骨远端骨折手法整复失败的治疗经验[J].中国矫形外科杂志,2008,20:1589-1591.
- [7]Prommersberger KJ,Lanz UB.Corrective osteotomy of the distal radius through volar approach[J].Tech Hand up Extrem Surg,2004,8:70-77.
- [8]Henry MH,Griggs SM,Levaro F,et al.Volar approach to dorsal displaced fractures of the distal radius[J].Tech Hand up Extrem Surg,2001,5:31-41.
- [9]Dodds SD,Cornelissen S,Jossan S,et al.A biomechanical comparison of fragment-specific fixation and augmented external fixation for intra-articular distal radius fractures[J].Hand Surg Am,2002,6:953.
- [10]Dennison DG.Open reduction and internal locked fixation of ustable distal ulna fractures with concomitant distal radius fracture[J].Hand Surg Am,2007,6:801-805.
- [11]刘振武,颜继英,杨朝晖,等.掌侧入路锁定钢板治疗桡骨远端不稳定骨折[J].华西医学,2010,1:134-136.
- [12]Moroni A,Faldini C,Marchetti S,et al.Improvement of the bonepin interface strength in osteoporotic bone with use of hydroxyapatite-coated tapered external-fixation pins.A prospective,randomized clinical study of wrist fractures[J].J Bone Joint Surg Am,2001,5:717-721.
- [13]Ladd AL,Pliam NB.The role of bone g raft and alternatives in unstable distal radius fracture treatment[J].Orthop Clin North Am,2001,2:337-351.
- [14]Baratz ME,Des Jardins J,Anderson DD,et al.Displaced intra-articular fractures of the distal radius:the effect of fracture displacement on contact stresses in a cadaver model[J].Hand Surg Am,1996,2:183.
- [15]吴有鲁,冯庆生,丁彩田,等.严重桡骨远端骨折的治疗[J].中国骨伤,2006,10:593-594.
- [16]Lattmann T,Dietrich M,Meier C,et al.Comparison of 2 surgical approaches for volar locking plate osteosynthesis of the distal radius[J].Hand Surg Am,2008,7:1135-1143.
- [17]胡庆丰,范顺武,周辉,等.掌侧“T”形锁定加压接骨板治疗老年桡骨远端骨折[J].中国骨伤,2007,4:268-269,270.
- [18]吴树华,王树金,王遥伟.二种方法治疗老年人不稳定桡骨远端骨折的临床分析[J].骨科,2012,3:120-121,132.
- [19]Rikli DA,Regazzoni P.Fractures of the distal end of the radius treatedby internal fixation and early function.A preliminary report of 20cases[J].J Bone Joint Surg Br,1996,78:588.
- [20]Gartland JJ,Werley CW.Evaluation of healed Colles'fractures[J].J Bone Joint Surg Am,1951,33:895-907.
- [21]Femandez DL,Jupiter JB.Fractures of the distal radius:a practical approach to management[M].New York:Sringer-Verlag,2005:996.