尺骨远端不稳定骨折合并桡骨远端骨折的髁钢板固定术

Condylar blade plate fixation of unstable fractures of the distal ulna associated with fracture of the distal radius.

作者信息

Ring David, McCarty L Pearce, Campbell Douglas, Jupiter Jesse B

机构信息

Harvard Medical School, Hand and Upper Extremity Service, Department of Orthopaedic Surgery, Massachusetts General Hospital, Ambulatory Care Center 525, 15 Parkman Street, Boston, MA 02114, USA.

出版信息

J Hand Surg Am. 2004 Jan;29(1):103-9. doi: 10.1016/j.jhsa.2003.10.019.

DOI:10.1016/j.jhsa.2003.10.019

PMID:14751112

Abstract

PURPOSE

To review the results of condylar blade plate fixation of unstable fractures of the distal ulna associated with fracture of the distal radius.

METHODS

Twenty-four patients in whom a minicondylar blade plate was used to repair an unstable fracture of the distal ulna associated with a fracture of the distal radius were reviewed retrospectively an average of 26 months (range, 12-50 months) after injury. According to the Q modifier of the Comprehensive Classification of Fractures, there were 1 simple fracture of the ulnar neck (Q2), 20 comminuted fractures of the ulnar neck (Q3), and 3 fractures of the head and neck (Q5). Subsequent surgeries included repeat fixation and autogenous cancellous bone grafting in 2 patients with nonunion of the distal radius and 1 with nonunion of the distal ulna. Seven patients had a second operation to remove the ulnar plate secondary to discomfort from plate prominence.

RESULTS

The final average motion was as follows: degrees of flexion (range, 30 degrees-80 degrees), 52 degrees of extension (range, 40 degrees-90 degrees), 76 degrees of pronation (range, 45 degrees-90 degrees), and 70 degrees of supination (range, 45 degrees-90 degrees). Grip strength averaged 64% of the contralateral, uninjured extremity (range, 35%-100%). Final radiographic measurements included an average palmar tilt of the distal articular surface of the radius of 8 degrees (range, 0 degrees-20 degrees of palmar tilt), ulnar inclination of 21 degrees (range, 15 degrees-25 degrees), and ulnar positive variance of 1 mm (range, 0-4 mm). There were no problems related to the distal radioulnar joint. According to the system of Gartland and Werley as modified by Sarmiento, there were 6 excellent, 15 good, and 4 fair results at final evaluation.

CONCLUSION

For unstable fractures of the distal ulna associated with fracture of the distal radius, condylar blade plate fixation can achieve healing with good alignment, satisfactory function, and an acceptable rate of secondary surgery.

摘要

目的

回顾应用髁钢板固定尺骨远端不稳定骨折合并桡骨远端骨折的结果。

方法

回顾性分析24例应用微型髁钢板修复尺骨远端不稳定骨折合并桡骨远端骨折的患者，受伤后平均随访26个月（范围12 - 50个月）。根据骨折综合分类的Q分型，尺骨颈简单骨折1例（Q2），尺骨颈粉碎性骨折20例（Q3），头颈部骨折3例（Q5）。后续手术包括2例桡骨远端骨不连患者的再次固定和自体松质骨移植，1例尺骨远端骨不连患者的自体松质骨移植。7例患者因钢板突出不适接受二次手术取出尺骨钢板。

结果

最终平均活动度如下：屈曲角度（范围30° - 80°），伸展52°（范围40° - 90°），旋前76°（范围45° - 90°），旋后70°（范围45° - 90°）。握力平均为对侧未受伤肢体的64%（范围35% - 100%）。最终影像学测量包括桡骨远端关节面平均掌倾角8°（范围掌倾0° - 20°），尺偏角21°（范围15° - 25°），尺骨正变异1mm（范围0 - 4mm）。桡尺远侧关节无相关问题。根据Sarmiento修改的Gartland和Werley系统，最终评估结果为6例优，15例良，4例可。