摘要
目的探讨经扩展桡侧腕屈肌入路，骨折灶内复位、取骨折近端松质骨植骨和掌侧双层软骨下支撑锁定接骨板固定治疗桡骨远端粉碎性骨折的临床效果。方法自2015年10月至2016年8月收治18例桡骨远端粉碎性骨折患者（AO分型为c3型），均采用扩展桡侧腕屈肌入路，切断桡侧间隔和肱桡肌腱止点、骨膜下解剖桡骨骨折近端和旋前骨折近端扩大暴露，并经骨折灶内复位和取近折端自体松质骨植骨支撑关节软骨下骨，掌侧双层软骨下支撑锁定接骨板固定，根据术中获取的自体松质骨量、术后腕关节活动、术后影像学检测和Gartland-Werley腕关节评分，分析临床疗效。结果术中获取自体松质骨量为1．2～3．1cm3，平均2．3cm3.术后所有患者随访9～19个月，平均12．4个月，所有骨折均愈合，无伸肌腱与正中神经损伤症状；术后9个月时，腕关节掌屈（51．24±4．72）°，背伸（48．86±6．32）°，桡偏（15．58±3．72）°，尺偏f24．67±5．82）°，旋前（76．34±11．54）°，旋后（74．58±10．56）°。Gartland—Werley腕关节评分：优7例、良8例、可2例、差1例。影像学检测结果：尺偏角13．1。～24．6°，平均23．8°；掌倾角10．3°～14．3°，平均13．20；桡骨高9．3～14．8mm，平均13．1mm。结论桡骨远端粉碎性骨折经扩展桡侧腕屈肌入路扩大了操作空间，骨折灶内操作技术能直视下复位骨折和利用松质骨植骨完成软骨下骨支撑，双层软骨下骨支撑接骨板能有效固定背侧、掌侧和中央骨折块，取得良好的临床疗效。
Objective To explore the clinical effect of fracture reduction, autologous cancellous bone graft and palmar double-tiered subchondral locking support plate fixation through the extended flexor carpi radialis approach for treatment of comminuted distal radius fractures. Methods From October 2015 to August 2016, a total of 18 cases of comminuted distal radius fractures （AO type C3） were treated. The extended flexor carpi radialis approach were applied by transection of radialis sepmm and brachioradialis tendon insertion. Proximal end of radius fractures were dissected subperiosteally and pronated to expand the exposure range. Proper reduction and autogenous cancellous bone graft harvested from the proximal radius were achieved by using the intrafocal technique. The fractures were fixed by a volar double-tiered subchondral support locking plate. The clinical effect was analyzed according to the amount of autologous cancellous bone, postoperative wrist activity, postoperative radiographic parameters and Gartland-Werley wrist score. Results The amount of autologous cancellous bone was 1.2 to 3.1 cm3, with an average of 2.3 cm3. All the patients were follow-up for 9 to 19 months, with an average of 12.4 months. All the fractures were healed. No extensor tendon and median nerve injury symptoms occurred. At 9 months after the operation, the activity of affected wrist was （51.24 ± 4.72）° on flexion, （48.86±6.32）° on extension, （15.58±3.72）°on radial deviation, （24.67±5.82）°on ulnar deviation, （76.34±11.54）° on pronation and （74.58±10.56）° on supination. According to the Gartland-Werley wrist score, the results were excellent in 7 cases, good in 8 cases, thir in 2 cases and poor in 1 case. The results of imaging examination showed that the ulnar deviation angle was 13.1° to 24.6° with an average of 23.8°, the volar tilt angle was 10.3° to 14.3° with an average of 13.2°, the radial height was 9.3 to 14.8 mm with an average of 13.1 mm. Conclusion The sufficient volar exposure by the extended flexor carpi radialis approach can facilitate the fracture reduction under direct vision and subchondral support with autogenous cancellous bone graft harvested from the proximal fragment using the intrafocal technique. And stable fixation of the dorsal, volar and central fragments with double-tieredsubchondral support plate can also facilitate the functional restoration in the treatment of comminuted distal radius fractures.
作者
褚庭纲
陈星隆
李志杰
蒋良福
杨景全
陈一衡
周飞亚
高伟阳
Chu Tinggang, Chen Xinglong, Li Zhijie, Jiang Liangfu, Yang Jingquan, Chen Yiheng, Zhou Feiya, Gao Weiyang(Department of Hand Surgery, the Second Affiliated Hospital of Wenzhou Medical University, Zhejiang 325027, Chin)
出处
《中华手外科杂志》
CSCD
北大核心
2018年第2期102-106,共5页
Chinese Journal of Hand Surgery
关键词
桡骨骨折
骨移植
扩展桡侧腕屈肌腱入路
骨折灶内技术
双层软骨下支撑
Radius fractures
Bone transplantation
Extended flexor carpi radialis approach
Intrafocal technique
Double-tiered subchondral support
