采用 Turner 半径和远端掌侧桡骨板固定治疗复杂关节内远端桡骨骨折。

The treatment of complex intra-articular distal radius fractures with turning radius and distal volaris radius plate fixation.

机构信息

Department of Osteoarthropathy and Institute of Orthopedic Research, Shenzhen People's Hospital, The Second Clinical Medical College of Jinan University and the First Affiliated Hospital of Southern University of Science and Technology, Shenzhen, 518035, Guangdong, China.

Department of Orthopaedics, Taian City Central Hospital, Taian, 271000, Shandong, China.

出版信息

Eur J Med Res. 2020 Dec 7;25(1):66. doi: 10.1186/s40001-020-00470-x.

DOI:10.1186/s40001-020-00470-x

PMID:33287905

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC7720610/

Abstract

BACKGROUND

Although distal radius fractures (DRFs) are clinically common, intra-articular DRFs accompanied by dorsally displaced free fragments are much less so. At present, it is very difficult to fix and stabilize the intra-articular distal radius fractures accompanying dorsally displaced free fragments with a plate. Our aim was to investigate the clinical effect of DRFs with distally displaced dorsal free mass treated with distal volaris radius (DVR) combined with turning of the radius via the distal palmar approach.

METHODS

From 2015 to 2019, 25 patients with intra-articular distal radius fractures associated with dorsally displaced free fragments were selected and treated with distal volaris radius (DVR) combined with turning of the radius via the distal palmar approach. This study involved 14 males and 11 females, with an average age of 34.5 years (ranging from 21 to 50 years). The mean follow-up period was 16.5 months (ranging from 12 to 22 months). The dorsal displacement of the free fragments was analyzed by X-ray and three-dimensional computed tomography, allowing characterization of postoperative recovery effects by radial height, volar tilt and radial inclination. For the follow-up, we evaluated effects of the surgery by analyzing range of motion (ROM); Modified Mayo Wrist Score (MMWS); and Disabilities of Arm, Shoulder and Hand (DASH) score. Postoperative wound recovery and complications were also monitored to evaluate the clinical therapeutic effects of the surgical procedures.

RESULTS

X-ray showed that all patients showed reduced fractures, well-healed wounds and recovered function with no obvious complications. Based on the follow-up, patients had a mean radial height of 10.5 mm (ranging from 8.1 to 12.6 mm), mean MMWS of 78.8° (ranging from 61° to 90°), mean DASH score of 16.25 (ranging from 11 to 21), mean ROM for volar flexion of 76.5° (ranging from 62° to 81°), mean ROM for dorsiflexion of 77.1° (ranging from 59 to 83) and mean VAS score of 1.4 (ranging from 1 to 3).

CONCLUSION

Treatment of the intra-articular distal radius fractures accompanying dorsally displaced free fragments with turning of the radius and the DVR plate system via the distal palmar approach is effective and has no obvious complications.

摘要

背景

桡骨远端骨折（DRF）虽临床常见，但伴背侧移位游离骨块的关节内 DRF 则少见。目前，用钢板固定和稳定伴背侧移位游离骨块的关节内桡骨远端骨折非常困难。我们旨在探讨通过掌侧远侧入路结合桡骨远端旋转移位治疗伴背侧移位游离骨块的 DRF 的临床效果。

方法

2015 年至 2019 年，我们选择了 25 例伴背侧移位游离骨块的关节内桡骨远端骨折患者，采用掌侧远侧桡骨（DVR）结合经掌侧远侧入路桡骨远端旋转移位进行治疗。本研究共纳入 14 例男性和 11 例女性患者，平均年龄 34.5 岁（21 至 50 岁）。平均随访时间为 16.5 个月（12 至 22 个月）。通过 X 线和三维 CT 分析游离骨块的背侧移位情况，以桡骨高度、掌倾角和桡骨倾斜角来评估术后恢复效果。随访时，我们通过分析关节活动度（ROM）、改良 Mayo 腕关节评分（MMWS）和上肢残疾问卷（DASH）评分来评估手术效果。还监测术后伤口恢复和并发症，以评估手术治疗的临床疗效。

结果

X 线显示所有患者骨折均复位良好，伤口愈合良好，功能恢复，无明显并发症。根据随访结果，患者桡骨高度平均为 10.5mm（8.1 至 12.6mm），MMWS 平均为 78.8°（61°至 90°），DASH 平均为 16.25（11 至 21），掌屈平均为 76.5°（62°至 81°），背伸平均为 77.1°（59 至 83），VAS 平均为 1.4（1 至 3）。