摘要
目的探讨桡骨远端Die．punch骨折的手术治疗效果。方法2005年1月至2011年12月，对15例有移位和复位效果不满意的桡骨远端Die-punch骨折患者采用早期手术治疗。骨折均经x线片和CT确诊，包括：背侧型4例，掌侧型1例，劈裂型2例，塌陷型5例，劈裂加塌陷型3例；合并桡尺远侧关节分离3例，合并尺骨茎突骨折3例。除背侧型采取背侧切口外，其余均采取掌侧切口。本组采用2．4mm或2．7mm解剖钛板固定6例，3．5mm钢板固定3例，螺钉固定3例，克氏针固定1例，克氏针结合外固定支架固定2例。伴桡尺远侧关节分离3例中，复位后不稳定者1例予克氏针固定5周，2例行植骨。结果所有切口均I期愈合，无神经血管损伤、内固定松动断裂和骨不连等并发症发生。15例均获得随访，时间9～28个月（平均13个月），其中1例复位不良者有轻度创伤性关节炎表现，腕关节功能按Samfiento标准进行评定：优9例，良5例，可1例；优良率为93．3％。结论桡骨远端Die—punch骨折是一种较特殊的关节内骨折，有移位和复位效果不满意者早期手术治疗效果较佳。
Objective To explore the treatment outcomes of surgical management of die-punch fractures of the distal radius. Methods Fifteen cases of die-punch fractures of distal radius with displacement and unsatisfactory reduction were operated between January 2005 and December 2011. The fractures were confirmed by X-ray and CT scans. There were 4 cases of dorsal fractures, 1 case of volar fracture, 2 cases of split fractures, 5 cases of fracture collapse and 3 cases of split fractures associated with collapse. Of the 15 cases, 3 cases were accompanied with distal radio-ulnar joint dissociation and 3 cases accompanied by ulnar styloid fracture. Volar surgical approach was taken for all the types except the dorsal fractures which were treated via dorsal approach. In this group, 2.4 mm or 2.7 mm anatomical titanium plate was used in 6 cases, 3.5 mm plate in 3 cases, screws in 3 cases, Kirschner wires in 1 case and Kirschner wires combined with external fixator in 2 cases. Of the 3 cases accompanied by distal radio-ulnar joint dissociation, one was still unstable after reduction and was fixed with Kirschner wire for 5 weeks. The other two had bone grafting. Results Primary healing of incisions was achieved in all the patients. There were no injuries to the nerves and vessels, no loosening or breakage of the implants and no fracture nonunion. All 15 cases were follow-up for 9 to 28 months with an average of 13 months. Mild traumatic arthritis of the wrist was seen in 1 case that had unsatisfactory fracture reduction. Wrist function was assessed according to Sarmiento scale and was rated as excellent in 9 cases, good in 5 cases and fair in 1 case, with an excellent and good rate of 93.3%. Conclusion Die-punch fracture of the distal radius is a special intra-articular fracture. Early surgical management should be conducted for cases with fracture displacement and unsatisfactory fracture reduction to obtain good results.
出处
《中华手外科杂志》
CSCD
北大核心
2014年第2期121-123,共3页
Chinese Journal of Hand Surgery
关键词
骨折
骨折固定术
桡骨远端
Fractures, bone
Fracture fixation
Distal radius
