摘要
背景:桡骨远端骨折与舟状骨骨折临床愈合时间以及所采用的石膏外固定体位、固定时间均有所不同,当两种骨折同时出现时,无法选择固定体位及确定固定时间。同时对桡骨远端骨折及腕舟状骨骨折行一期内固定修复治疗能够获得良好功能。目的:回顾性分析新鲜不稳定型桡骨远端合并舟状骨骨折行锁定加压钛板及Herbert钉置入内固定的修复效果。方法:2011年11月至2014年6月山西大医院共收治新鲜不稳定型桡骨远端骨折合并舟状骨骨折获得完整随访患者共12例,均采用桡骨远端切开复位锁定加压钛板内固定,舟状骨切开复位或经皮Herbert钉内固定治疗。随访期间观察骨折愈合情况,治疗后6个月采用改良Mc Bride评分对腕关节功能进行评定,测量掌屈、背伸、尺偏、桡偏、旋前、旋后活动度及握力,X射线片下测量桡骨远端短缩情况(桡尺骨茎突高度差)以及尺偏角和掌倾角的角度,分别进行健侧与患侧对比。结果与结论:112例患者均得到完整随访,时间6-24个月。2桡骨远端及舟状骨骨折全部愈合,桡骨远端愈合时间6-12周,平均7周;舟状骨骨折愈合时间3-6个月,平均4.2个月。3腕关节功能评分采用改良的Mc Bride评分标准,治疗后6个月时进行评定,其中优5例,良6例,可1例,优良率为92%。4患者腕关节健侧与患侧掌屈、背伸、尺偏、桡偏、旋前、旋后活动度及握力,掌倾角、尺偏角、桡尺骨茎突高度差,以及改良Mcbide评分对比,差异均无显著性意义(P>0.05)。52例正中神经损伤患者经过术后探查减压后均于6个月内恢复。无感染、背侧肌腱激惹症状、腕管综合征、内固定失效等并发症发生。6提示新鲜不稳定型桡骨远端骨折合并舟状骨骨折行桡骨远端切开复位锁定加压钛板内固定,舟状骨切开复位或经皮Herbert钉内固定修复,具有内固定可靠、骨折愈合率高、腕关节功能恢复好等优点,修复效果满意。
BACKGROUND： Healing time and plaster used in fixed position and fixed time are different between distal radius fractures and scaphoid fracture. When both fractures occur simultaneously, you cannot choose a fixed position and determine a fixed time. One-stage internal fixation for the distal radial fractures and scaphoid fractures simultaneously can obtain a good function.OBJECTIVE： To retrospectively analyze the effects of titanium locking compression plate and Herbert screw fixation for fresh unstable distal radial fractures with scaphoid fracture. METHODS： A total of 12 patients with fresh unstable distal radial fractures combined with scaphoid fracture were treated in the Shanxi Dayi Hospital from November 2011 to June 2014. All cases received open reduction and locking compression plate fixation of the distal radius, open reduction of scaphoid fracture or percutaneous Herbert screw fixation. Fracture healing was observed during follow-up. At 6 months after treatment, wrist joint function was evaluated with modified Mc Bride score. Range of motion of palmar flexion, dorsiflexion, ulnar deviation, radial deviation, pronation and supination and grip strength were measured. The distal radial shortening（difference in height of styloid process of radius and ulna）, and angles of ulnar deviation and palmar tilt were measured with X-ray films. The data of healthy side and affected side were compared. RESULTS AND CONCLUSION：（1） 12 cases were followed up for 6-24 months.（2） The distal radius and scaphoid fractures healed. The healing time of distal radius was 6-12 weeks, with an average of seven weeks. Healing time of scaphoid fracture was 3-6 months, with an average of 4.2 months.（3） Wrist score was evaluated using modified Mc Bride scoring criteria at 6 months after treatment. There were excellent in 5 cases, good in 6 cases, and average in 1 case, with the excellent and good rate of 92%.（4） No significant difference in range of motion of palmar flexion, dorsiflexion, ulnar deviation, radial deviation, pronation and supination and grip strength, angles of ulnar deviation and palmar tilt, difference in height of styloid process of radius and ulna and modified Mc Bride score was detected between healthy side and affected side（P〉0.05）.（5） The median nerve injury in two patients was recovered within 6 months after postoperative exploration decompression. No complications appeared, such as infection, dorsal muscle tendon irritation symptoms, carpal tunnel syndrome, and internal fixation failure.（6） These findings confirm that fresh unstable distal radial fractures with scaphoid fractures can be treated with open reduction of the distal radius and locking plate fixation, open reduction of scaphoid bone or percutaneous Herbert screw fixation, with reliable fixation, high fracture healing rate, and good wrist function recovery rate; the repair effect is satisfactory.
出处
《中国组织工程研究》
CAS
北大核心
2016年第13期1880-1887,共8页
Chinese Journal of Tissue Engineering Research
