Smith Dean W, Henry Mark H
Department of Orthopaedics, University of Texas School of Medicine, Houston, TX, USA.
J Am Acad Orthop Surg. 2005 Jan-Feb;13(1):28-36. doi: 10.5435/00124635-200501000-00005.
The treatment of unstable distal radius fractures continues to improve as better methods of skeletal fixation and soft-tissue management are developed. Apart from closed reduction and percutaneous pinning of simpler fracture patterns, the three main methods of management are external fixation, dorsal plating, and volar fixed-angle plating. Specific advantages of volar fixed-angle plating include stable fixed-angle support that permits early active wrist rehabilitation, direct fracture reduction, and fewer soft-tissue and tendon problems. Volar fixed-angle plating also avoids the complications often associated with external fixation and dorsal plating. Biomechanical data indicate that, when loaded to failure, volar fixed-angle plates have significant strength advantages over dorsal plating. Volar fixed-angle plating is advantageous in elderly osteopenic patients and for high-energy comminuted fractures and malunions requiring osteotomy.
随着骨骼固定和软组织处理方法的不断改进，桡骨远端不稳定骨折的治疗效果持续提升。除了对较简单骨折类型进行闭合复位和经皮穿针固定外，主要的三种治疗方法是外固定、背侧钢板固定和掌侧角度固定钢板固定。掌侧角度固定钢板的具体优势包括稳定的角度固定支撑，可使腕关节早期进行主动康复、直接复位骨折，以及减少软组织和肌腱问题。掌侧角度固定钢板还可避免外固定和背侧钢板固定常伴发的并发症。生物力学数据表明，在承受至失效载荷时，掌侧角度固定钢板比背侧钢板具有显著的强度优势。掌侧角度固定钢板对于老年骨质疏松患者以及需要截骨术的高能粉碎性骨折和畸形愈合患者具有优势。
