摘要
[目的]评价对桡骨远端关节内骨折进行Medoff分型细化分型,采用相应的微创手术治疗的临床结果。[方法]回顾分析2022年9月—2024年6月53例桡骨远端关节内骨折患者的资料。运用Medoff分型细化分析,依据特异性骨折块的特点,大骨块者(>8 mm)采取掌侧微创经皮钢板接骨(minimally invasive percutaneous plate osteosynthesis,MIPPO);小骨块者(≤8 mm)采取闭合复位或者掌侧MIPPO小切口复位,克氏针三角框架式固定+外固定架固定。评价患者的临床和影像资料。[结果]53例患者均顺利手术,复位后,透视及镜下关节面均平整17例,占32.1%;透视发现台阶14例,占26.4%;透视平整,镜下仍有台阶或分离22例,占41.5%;对复位不良者,镜下再给予细致复位。随访平均(9.5±0.6)个月。随术后1、3、6个月的时间推移,Mayo腕关节评分[分,(44.3±5.5),(71.9±6.2),(88.9±8.6),P<0.001]、疼痛VAS评分[分,(4.2±1.9),(1.1±14),(0.6±0.9),P<0.001],腕关节背伸-掌屈ROM[°,(29.4±3.4),(117.1±13.3),(169.4±12.1),P<0.001]、尺偏-桡偏ROM[°,(7.8±1.9),(38.5±5.9),(50.0±5.4),P<0.001]和前臂旋前-旋后ROM[°,(77.1±110.6),(121.2±12.7),(153.8±8.3),P<0.001]均显著改善。影像方面,与术后1周相比,术后3个月和术后6个月的掌倾角(palmar tile,PT)、尺偏角(radial inclination,RI)和桡骨茎突高度(radial length,RL)均无显著变化(P>0.05)。[结论]Medoff分型细化分析后能够囊括绝大多数桡骨远端关节内骨折病例,可较为准确评价桡骨远端骨折的粉碎程度,对手术方式的选择有明确的指导意义。本研究所用微创手术方法是可行和有效的。
[Objective]To evaluate the clinical outcomes of minimally invasive surgical treatment for distal radius intra-articular frac⁃tures based on the Medoff classification refinement.[Methods]A retrospective research was conducted on 53 patients who distal radius in⁃tra-articular fractures treated surgically from September 2022 to June 2024.The Medoff classification refinement was used to analyze the specific characteristics of the fracture fragments.For large bone fragments(>8 mm),minimally invasive percutaneous plate osteosynthesis(MIPPO)on the palmar side was adopted,while for small bone fragments(≤8 mm),closed reduction or palmar MIPPO with small incision re⁃duction was performed,combined with Kirschner wire triangular frame fixation or external fixator fixation.The clinical and imaging data of the patients were evaluated.[Results]All 53 patients underwent the individualized operation successfully.After initial reduction,the joint surface was smooth on fluoroscopy and under the arthroscope in 17 cases(32.1%);steps on fluoroscopy were noted in 14 cases(26.4%);the joint surface was smooth on fluoroscopy,but there were still steps or separation under the arthroscope in 22 cases(41.5%).For those with poor reduction,detailed reduction was performed again under the arthroscope.The follow-up was lasted for(9.5±0.6)months in a mean.With time elapsed 1 month,3 months and 6 months after surgery,the Mayo wrist score[(44.3±5.5),(71.9±6.2),(88.9±8.6),P<0.001],pain VAS score[(4.2±1.9),(1.1±14),(0.6±0.9),P<0.001],wrist extension-flexion range of motion(ROM)[°,(29.4±3.4),(117.1±13.3),(169.4±12.1),P<0.001],ulnar-radial deviation ROM[°,(7.8±1.9),(38.5±5.9),(50.0±5.4),P<0.001]and forearm pronation-supination ROM[°,(77.1±110.6),(121.2±12.7),(153.8±8.3),P<0.001]significantly improved.Regarding imaging,the palmar tilt(PT),radial inclination(RI),and radial length(RL)remained unchanged significantly 3 and 6 months after surgery compared with those 1 week postoperatively(P>0.05).[Conclusion]The refinement of Medoff classification can cover the vast majority of distal radius intra-articular fracture cases,accurately evaluate the degree of comminution of distal radius fractures,and have clear guiding significance for the selection of surgical methods.Our minimally invasive surgical method is feasible and effective.
作者
王桂龙
刘加田
邱世超
韩舜
国涛
娄树磊
魏宝富
WANG Gui-long;LIU Jia-tian;QIU Shi-chao;HAN Shun;GUO Tao;LOU Shu-lei;WEI Bao-fu(Department of Hand and Foot Surgery,New District Hospital,Linyi People's Hospital,Linyi 276003,Shandong,China;D Printing Center,New District Hospital,Linyi People's Hospital,Linyi 276003,Shandong,China)
出处
《中国矫形外科杂志》
北大核心
2026年第4期372-377,共6页
Orthopedic Journal of China
关键词
桡骨远端关节内骨折
分型
微创手术
精准治疗
distal radius intra-articular fractures
classification
minimally invasive surgery
precise treatment
