Cheng Ya-Bo, Yang Shun
Department of Orthopaedics Trauma and Hand Surgery, Orthopaedics Hospital of Sichuan Province, Chengdu 610041, Sichuan, China;
Department of Orthopaedics Trauma and Hand Surgery, Orthopaedics Hospital of Sichuan Province, Chengdu 610041, Sichuan, China.
Zhongguo Gu Shang. 2016 Sep 25;29(9):859-862. doi: 10.3969/j.issn.1003-0034.2016.09.017.
To explore the clinical efficacy of internal fixation with arthroscope assistance in type B fractures of distal radius.
From June 2013 to July 2015, 28 cases of type B distal radius fracture patients were enrolled into the study, including 15 males and 13 females with an average age of 45.3 years old ranging from 17 to 69 years old. These patients were treated with manipulative and poking reduction wrist arthroscopy, internal fixation with Herbert screws and repair of articular soft tissue, and the course of disease was 4 to 7 days after injury. Injured patients had the typical signs of distal radius fracture with confirming of X ray and CT imaging. Finally, no other fractures, no neurovascular injury, no other severe diseases and no surgical cortraindications were identified. According to the classification of AO/OTA, there were 8 cases of type B1, 7 cases of type B2, 13 cases of type B3. Patients were followed up for fracture healing, wrist joint function recovery, and curative effect.
The 28 cases of type B distal radius fractures were followed up with an average of(12.1±1.4) months, all fractures were healed, palmer tilt angle was(15.2±3.4)°, ulnar drift angles was(20.4±6.4)°. Wrist functions were evaluated according to Cooney system and rated as excellent in 21 cases, good in 5 cases and fair in 2 cases. Intraoperative arthroscopy showed the tear of scapholunate ligaments in 3 cases, tear of in lunotriguetal ligaments in 1 case, and TFCC tear in 16 cases.
Wrist arthroscopy assisted treatment of distal radius fracture type B can make the recovery of joint surface roughness to a great extent. The application of Herbert screw brings in the small trauma, and the postoperative recovery time is short, reducing the incidence of traumatic arthritis and preventing the chronic pain or inastbility of the wrist in the future.
探讨关节镜辅助下内固定治疗桡骨远端B型骨折的临床疗效。
选取2013年6月至2015年7月收治的28例桡骨远端B型骨折患者，其中男15例，女13例，平均年龄45.3岁，年龄范围17～69岁。均采用手法整复经皮穿针腕关节镜辅助下Herbert螺钉内固定及关节软组织修复术治疗，受伤至手术时间4～7天。受伤患者均有典型的桡骨远端骨折体征，经X线及CT影像学检查确诊。排除合并其他骨折、神经血管损伤、其他严重疾病及手术禁忌证者。按照AO/OTA分类，B1型8例，B2型7例，B3型13例。观察患者骨折愈合、腕关节功能恢复及疗效情况。
28例桡骨远端B型骨折患者平均随访（12.1±1.4）个月，骨折均愈合，掌倾角为（15.2±3.4）°，尺偏角为（20.4±6.4）°。按Cooney评分系统评定腕关节功能，优21例，良5例，可2例。术中关节镜检查发现舟月韧带撕裂3例，月三角韧带撕裂1例，三角纤维软骨复合体（TFCC）撕裂16例。
腕关节镜辅助治疗桡骨远端B型骨折能使关节面平整度得到较大程度恢复。Herbert螺钉的应用创伤小，术后恢复时间短，减少了创伤性关节炎的发生，预防了腕关节后期慢性疼痛及不稳。
