De Smet A, Lamouille J, Vostrel P, Loret M, Hoffmeyer P, Beaulieu J-Y
Unité de chirurgie de la main et des nerfs périphériques, service d'orthopédie et traumatologie de l'appareil moteur, hôpital universitaire de Genève (HUG), rue Gabrielle-Perret-Gentil 4, 1205 Genève, Switzerland.
Unité de chirurgie de la main et des nerfs périphériques, service d'orthopédie et traumatologie de l'appareil moteur, hôpital universitaire de Genève (HUG), rue Gabrielle-Perret-Gentil 4, 1205 Genève, Switzerland.
Hand Surg Rehabil. 2016 Jun;35(3):203-209. doi: 10.1016/j.hansur.2016.01.006. Epub 2016 May 11.
The treatment of impacted distal radius fractures is complex. Internal fixation by a dorsal approach with arthrotomy should be considered, particularly when the fractures are dorsally comminuted. This was a retrospective, observational study of 26 patients operated between 2008 and 2012 who were reviewed in September 2013. In the surgical procedure, a single dorsal incision was made over the distal radius and arthrotomy performed; the fracture site was stabilized with two 2.4mm locking plates. The average follow-up was 39months. All fractures were type 23C in the AO classification. All patients were assessed with the QuickDASH and Mayo Wrist scores. Total range of motion was 82% of the contralateral side. Grip strength was 30kg in average. The mean radial sagittal tilt was +6° postoperatively. No plate movement or intra-articular screws were present. Four patients developed symptomatic early osteoarthritis. Thirteen patients had the plate removed due to discomfort. No tendon ruptures were observed. The dorsal approach remains a treatment option for specific intra-articular fractures. It offers direct intra-articular congruency control, along with a stable buttress and locking fixation for early mobilization. Our results are comparable to those using other surgical techniques for this type of high-energy fracture.
桡骨远端嵌插骨折的治疗较为复杂。对于背侧粉碎性骨折，尤其应考虑采用经关节切开的背侧入路进行内固定。这是一项回顾性观察研究，对2008年至2012年间接受手术的26例患者进行了研究，并于2013年9月进行了复查。手术过程中，在桡骨远端做一个单一的背侧切口并进行关节切开；骨折部位用两块2.4mm锁定钢板固定。平均随访时间为39个月。所有骨折在AO分类中均为23C型。所有患者均采用QuickDASH和梅奥腕关节评分进行评估。总活动范围为对侧的82%。平均握力为30kg。术后平均桡骨矢状面倾斜度为+6°。未出现钢板移位或关节内螺钉情况。4例患者出现症状性早期骨关节炎。13例患者因不适取出了钢板。未观察到肌腱断裂。背侧入路仍然是特定关节内骨折的一种治疗选择。它能直接控制关节内的一致性，同时提供稳定的支撑和锁定固定以便早期活动。我们的结果与使用其他手术技术治疗此类高能量骨折的结果相当。
