经切开复位内固定治疗桡骨远端骨折的临床效果。

Peking University People's Hospital, Beijing 100044, China.

Chin Med J (Engl). 2012 Jan;125(1):140-3.

BACKGROUND

For some specific comminuted unstable intra-articular fracture, the plaster cast can not maintain the alignment of the articular surface effectively. The aim of this study was to evaluate the clinical effects of distal radius fracture treated with open reduction and internal plate fixation retrospectively.

METHODS

From January 2002 to March 2010, 539 cases of distal radius fracture were treated with open reduction and internal fixation, including 184 males and 355 females aging 21 - 72 years (mean 57 years). Fractures were caused by falling to the ground in 459 cases, by traffic accident in 62 cases and by athletic injuries in 18 cases. Of 539 cases, there were 523 cases of closed fracture and 16 cases of open fracture. According to Arbeitsgemeinschaft fur Osteosynthesefragen (AO) standards of classification, there were 14 cases of A2 type, 22 of A3 type, 18 of B1 type, 24 of B2 type, 62 of B3 type, 91 of C1 type, 162 of C2 type and 146 of C3 type. The time from injury to operation was 1 - 16 days (mean 5 days). All patitents received open reduction and internal plate screw fixation. Forty-seven patients with bone defect were given 6 - 15 g autologous ilium and 75 cases were given 5 ml calcium sulphate artificial aggregate after reduction.

RESULTS

All incisions healed by first intention after operation. Patients were followed up for 15 to 32 months postoperatively (mean 22 months). The fractures healed within 10 - 18 weeks after operation (mean 12 weeks). During the last follow-up, the mean palmar tilt was (7.0 ± 0.9)° and the mean ulnar variance was (21.0 ± 4.2)°, showing significant difference when compared with preoperation ((-5.0 ± 1.2)° and (8.0 ± 3.8)°). The radial heights were not abbreviated. According to Gartland and Werley assessment system, the results were excellent in 314 cases, good in 163 cases, fair in 46 cases, and poor in 16 cases 12 weeks after operation, the excellent and good rate was 88.5%.

CONCLUSIONS

The clinical effect of distal radius fracture treated with open reduction and internal plate fixation was relatively satisfactory. Meticulous operation procedure and individual rehabilitation strategy contribute to the wrist joint functional recovery.

背景

对于某些特定的粉碎性不稳定关节内骨折，石膏固定无法有效维持关节面的对线。本研究旨在回顾性评估切开复位内固定治疗桡骨远端骨折的临床效果。

方法

自 2002 年 1 月至 2010 年 3 月，采用切开复位内固定治疗桡骨远端骨折 539 例，男 184 例，女 355 例，年龄 2172 岁，平均 57 岁。459 例为跌倒伤，62 例为交通事故伤，18 例为运动伤。539 例中，闭合性骨折 523 例，开放性骨折 16 例。按 Arbeitsgemeinschaft fur Osteosynthesefragen（AO）骨折分型标准：A2 型 14 例，A3 型 22 例，B1 型 18 例，B2 型 24 例，B3 型 62 例，C1 型 91 例，C2 型 162 例，C3 型 146 例。受伤至手术时间 116 天，平均 5 天。所有患者均行切开复位内固定钢板螺钉固定。47 例骨缺损患者给予 6~15 g 自体髂骨，75 例给予 5 ml 硫酸钙人工骨骨料。

结果

术后切口均一期愈合。患者均获随访，随访时间 15~~32 个月，平均 22 个月。骨折均获愈合，愈合时间 10~~18 周，平均 12 周。末次随访时，掌倾角为（7.0±0.9）°，尺偏角为（21.0±4.2）°，与术前比较差异有统计学意义[（-5.0±1.2）°、（8.0±3.8）°]。桡骨高度无缩短。按 Gartland 和 Werley 腕关节功能评定标准：术后 12 周优 314 例，良 163 例，可 46 例，差 16 例，优良率 88.5%。