[桡骨远端骨折畸形愈合的截骨矫正术结果评估]

Zyluk Andrzej, Niedźwiedź Zygmunt

Klinika Chirurgii Ogólnej i Chirurgii Reki, Pomorska Akademia Medyczna w Szczecinie.

Chir Narzadow Ruchu Ortop Pol. 2008 Jan-Feb;73(1):41-8.

INTRODUCTION

Malunion is the most common and serious complications after fracture of the distal radius. Alterations of the normal biomechanics affect function of the wrist, which is associated with pain, disability and, in longer perspective, with arthrosis. Reestablishment of the normal anatomic relationships by corrective osteotomy is one of the most effective ways to prevent this scenario.

PATIENTS AND METHODS

Twenty-five consecutive patients, 19 women and 6 men with the mean age of 50 years with malunited fractures of the distal radius underwent corrective osteotomy. Operations were performed at mean of 8 months after precipitated fracture and indications included pain, reduction of wrist movement, loss of grip strength and wrist deformity. Regarding to direction of the dislocation, operations were done through a dorsal (20 patients) or volar (5 patients) approach, post-osteotomy defect in the distal radius was flied with cancellous bone graft form the iliac crest in 20 patients or allogenous bone graft in 5 patients and bone fixation was done with K-wires In 18 patients or with T-plate in 7 patients. The results were assessed at mean of 2 years with two standardized questionnaires: Gartland-Werley and DASH.

RESULTS

The average pre-operative DASH score was of 115 points (range 76-132) indicated severe disability of the hand. At the last follow-up assessment it decreased to a mean of 47 points (range 30-100) indicating statistically significant improvement the hand function. In Gartland-Werley scale, 9 patients (36%) achieved excellent, 11 (44%) good, 3 (12%) fair and 2 patients (8%) poor result. Two cases of poor results were caused by complications. Failure of the K-wires bone fixation with concomitant infection caused dislocation of the bone graft and collapse of the distal radius. In the second case, an allogenous bone graft did not heal, but disintegrated, what resulted in the total deformation of the distal radius.

引言

桡骨远端骨折后畸形愈合是最常见且严重的并发症。正常生物力学的改变会影响腕关节功能，进而导致疼痛、功能障碍，从长远来看还会引发关节炎。通过截骨矫形重建正常解剖关系是预防这种情况的最有效方法之一。

患者与方法

连续25例桡骨远端骨折畸形愈合患者接受了截骨矫形手术，其中19例女性，6例男性，平均年龄50岁。手术平均在伤后8个月进行，手术指征包括疼痛、腕关节活动度降低、握力丧失和腕关节畸形。根据脱位方向，20例患者通过背侧入路、5例患者通过掌侧入路进行手术。20例患者桡骨远端截骨后骨缺损采用取自髂嵴的松质骨移植填充，5例患者采用异体骨移植填充；18例患者采用克氏针固定，7例患者采用T形钢板固定。采用Gartland-Werley和DASH两种标准化问卷在平均2年时对结果进行评估。

结果

术前DASH评分平均为115分（范围76 - 132分），表明手部严重功能障碍。在最后一次随访评估时，该评分降至平均47分（范围30 - 100分），表明手部功能有统计学意义的显著改善。在Gartland-Werley量表中，9例患者（36%）结果为优，11例（44%）为良，3例（12%）为中，2例患者（8%）为差。2例差的结果是由并发症导致的。克氏针内固定失败并伴有感染，导致植骨块移位和桡骨远端塌陷。在第二例中，异体骨移植未愈合反而溶解，导致桡骨远端完全变形。