Teipner W A, Mast J W
Orthop Clin North Am. 1980 Jul;11(3):381-91.
Eighty-four fresh diaphyseal fractures of the forearm in 55 patients were treated by double plates, with bone union occurring in 97.6 per cent. Seventy fresh diaphyseal fractures of the forearm in 48 patients were treated by single compression plates (tension band plates) with bone union occurring in 100 per cent. In both series, other than infection (two in the double plating series and none in the compression plating series), the major complication was synostosis. This matter is being further investigated at this time by one of the authors (JWM) in an attempt to abort this most distressing complication. The other major complication is related to the stress riser effect of the implant, particularly after hardware removal. There still remains some difference of opinion as to whether metal has to be removed, and in general, unless there is a clear-cut indication for its removal, we do not do so. We now believe that double plating and single compression plating (tension band plating) will insure a high rate of union, a generally excellent functional result, and a low complication rate. However, ASIF (AO) plating provides a somewhat shorter operative time and, at least theoretically, less stress protection of bone and possibly less devitalization of tissue because of the need for less soft tissue stripping for exposure. Therefore, in our clinic for the most part we now use single tension band plating for displaced diaphyseal fractures of the forearm in the adult.
对55例患者的84处新鲜尺桡骨干骨折采用双钢板治疗，骨愈合率为97.6%。对48例患者的70处新鲜尺桡骨干骨折采用单块加压钢板（张力带钢板）治疗，骨愈合率为100%。在这两个系列中，除感染外（双钢板固定组2例，加压钢板固定组无感染），主要并发症是骨桥形成。目前，其中一位作者（JWM）正在对此进行进一步研究，试图避免这种最令人苦恼的并发症。另一个主要并发症与植入物的应力集中效应有关，尤其是在取出内固定物之后。对于是否必须取出金属内固定物仍存在一些不同意见，一般来说，除非有明确的取出指征，否则我们不会这样做。我们现在认为，双钢板固定和单块加压钢板（张力带钢板）固定将确保高愈合率、总体良好的功能结果和低并发症发生率。然而，AO钢板固定的手术时间稍短，至少从理论上讲，由于暴露所需的软组织剥离较少，对骨的应力保护作用较小，对组织的活力影响也较小。因此，在我们的诊所，目前对于成人尺桡骨干移位骨折，大部分情况下我们采用单张力带钢板固定。
