中华创伤骨科杂志
中華創傷骨科雜誌
중화창상골과잡지
CHINESE JOURNAL OF ORTHOPAEDIC TRAUMA
2012年
2期
117-121
,共5页
桑伟林%王建东%王秋根%高伟%李豪青%李凡%黄建华%陶杰%吴晓明%周孜辉%汪方%吴小峰
桑偉林%王建東%王鞦根%高偉%李豪青%李凡%黃建華%陶傑%吳曉明%週孜輝%汪方%吳小峰
상위림%왕건동%왕추근%고위%리호청%리범%황건화%도걸%오효명%주자휘%왕방%오소봉
桡骨骨折%骨折固定术,内%骨板%手术入路
橈骨骨摺%骨摺固定術,內%骨闆%手術入路
뇨골골절%골절고정술,내%골판%수술입로
Radius fractures%Fracture fixation,internal%Bone. plates%Surgical approach
目的 探讨桡骨远端C3.1型骨折的手术入路及固定方法. 方法 回顾性分析2007年1月至2009年8月收治且获得随访的40例桡骨远端C3.1型骨折患者资料,男17例,女23例；年龄47～65岁(平均58.2岁).根据手术入路不同分为掌侧入路组(25例,单纯掌侧入路锁定钢板内固定11例,掌侧入路加背侧辅助切口克氏针、螺钉内固定14例)和背侧入路组(15例,均采用背侧入路锁定钢板内固定),比较两组患者的骨折愈合时间、术后12个月掌倾角、尺偏角及桡骨茎突高度,以及术后6、24个月腕关节活动度.结果 40例患者术后获平均2.3年(2.0～2.5年)随访.两组患者骨折愈合时间[(8.1±2.2)、(8.3±1.7)周]、术后12个月掌倾角(9.3°±2.1°、9.5°±1.7°)、尺偏角(20.0°±2.7°、18.7°±2.5°)、桡骨茎突高度[(8.6±2.9)、(7.9±2.3) mm]比较差异均无统计学意义(P＞0.05).术后6个月背侧入路组腕关节掌屈(58.3°±1.7°)、背伸(55.0°±1.6°)活动度较掌侧入路组(67.5°±2.0°、59.2°±1.9°)差,差异有统计学意义(P＜0.05),两组患者旋前、旋后活动度差异无统计学意义(P＞0 05)；术后24个月两组患者腕关节活动度差异均无统计学意义(P＞0.05).背侧入路组1例术后1个月出现骨折复位丢失,3例于术后1年取出内固定物. 结论 与背侧入路锁定钢板内固定相比,掌侧入路锁定钢板内固定(或加背侧辅助切口)治疗桡骨远端C3.1型骨折可以更好地恢复和维持关节面骨折块的复位,术后并发症少,更有利于早期进行功能锻炼.
目的 探討橈骨遠耑C3.1型骨摺的手術入路及固定方法. 方法 迴顧性分析2007年1月至2009年8月收治且穫得隨訪的40例橈骨遠耑C3.1型骨摺患者資料,男17例,女23例；年齡47～65歲(平均58.2歲).根據手術入路不同分為掌側入路組(25例,單純掌側入路鎖定鋼闆內固定11例,掌側入路加揹側輔助切口剋氏針、螺釘內固定14例)和揹側入路組(15例,均採用揹側入路鎖定鋼闆內固定),比較兩組患者的骨摺愈閤時間、術後12箇月掌傾角、呎偏角及橈骨莖突高度,以及術後6、24箇月腕關節活動度.結果 40例患者術後穫平均2.3年(2.0～2.5年)隨訪.兩組患者骨摺愈閤時間[(8.1±2.2)、(8.3±1.7)週]、術後12箇月掌傾角(9.3°±2.1°、9.5°±1.7°)、呎偏角(20.0°±2.7°、18.7°±2.5°)、橈骨莖突高度[(8.6±2.9)、(7.9±2.3) mm]比較差異均無統計學意義(P＞0.05).術後6箇月揹側入路組腕關節掌屈(58.3°±1.7°)、揹伸(55.0°±1.6°)活動度較掌側入路組(67.5°±2.0°、59.2°±1.9°)差,差異有統計學意義(P＜0.05),兩組患者鏇前、鏇後活動度差異無統計學意義(P＞0 05)；術後24箇月兩組患者腕關節活動度差異均無統計學意義(P＞0.05).揹側入路組1例術後1箇月齣現骨摺複位丟失,3例于術後1年取齣內固定物. 結論 與揹側入路鎖定鋼闆內固定相比,掌側入路鎖定鋼闆內固定(或加揹側輔助切口)治療橈骨遠耑C3.1型骨摺可以更好地恢複和維持關節麵骨摺塊的複位,術後併髮癥少,更有利于早期進行功能鍛煉.
목적 탐토뇨골원단C3.1형골절적수술입로급고정방법. 방법 회고성분석2007년1월지2009년8월수치차획득수방적40례뇨골원단C3.1형골절환자자료,남17례,녀23례；년령47～65세(평균58.2세).근거수술입로불동분위장측입로조(25례,단순장측입로쇄정강판내고정11례,장측입로가배측보조절구극씨침、라정내고정14례)화배측입로조(15례,균채용배측입로쇄정강판내고정),비교량조환자적골절유합시간、술후12개월장경각、척편각급뇨골경돌고도,이급술후6、24개월완관절활동도.결과 40례환자술후획평균2.3년(2.0～2.5년)수방.량조환자골절유합시간[(8.1±2.2)、(8.3±1.7)주]、술후12개월장경각(9.3°±2.1°、9.5°±1.7°)、척편각(20.0°±2.7°、18.7°±2.5°)、뇨골경돌고도[(8.6±2.9)、(7.9±2.3) mm]비교차이균무통계학의의(P＞0.05).술후6개월배측입로조완관절장굴(58.3°±1.7°)、배신(55.0°±1.6°)활동도교장측입로조(67.5°±2.0°、59.2°±1.9°)차,차이유통계학의의(P＜0.05),량조환자선전、선후활동도차이무통계학의의(P＞0 05)；술후24개월량조환자완관절활동도차이균무통계학의의(P＞0.05).배측입로조1례술후1개월출현골절복위주실,3례우술후1년취출내고정물. 결론 여배측입로쇄정강판내고정상비,장측입로쇄정강판내고정(혹가배측보조절구)치료뇨골원단C3.1형골절가이경호지회복화유지관절면골절괴적복위,술후병발증소,경유리우조기진행공능단련.
Objective To discuss the surgical approaches and fixation methods for displaced type C3.1 fractures of distal radius. Methods Between January 2007 and August 2009,40 patients with type C3.1 fracture of distal radius were treated in our department.They were 17 men and 23 women,aged from 47 to 65 years (average,58.2 years).They were divided into 2 groups according to the surgical approach adopted.In group A,the simple volar approach plus locking plating was adopted in 11 cases and the volar approach plus auxiliary incision through the dorsal approach plus internal fixation with Kirschner wire and screws was adopted in 14 cases.In group B,the dorsal approach plus dorsal approach locking plating was adopted in 15 patients.The 2 groups were compared in terms of fracture healing time,palmar tilt,radial inclination and radial styloid height at 12 months postoperation and range of motion of the wrist at 6 and 24 months postoperation. Results The average follow-up period was 2.3 years (range,2.0 to 2.5 years).Bone union was achieved in all patients.There were no significant differences between the 2 groups in fracture healingtome (8.1±2.2 vs.8.3±1.7),palmar tilt (9.3°±2.1° vs.9.5°±1.7°),radial inclination (20.0° ± 2.7° vs.18.7° ± 2.5°) and radial styloid height (8.6 ± 2.9 mm vs.7.9 ± 2.3 mm) at 12 monthspostoperation ( P ＞ 0.05 ).The palmar flexion (58.3° ± 1.7°) and dorsal extension (55.0° ± 1.6°) at 6 months postoperation in group B were significantly smaller than those (67.5° ± 2.0° and 59.2° ± 1.9° ) in group A ( P ＜ 0.05),but there was no significant difference between the 2 groups in pronation or supination ( P ＞ 0.05).There was no significant difference between the 2 groups in the range of motion of the wrist at 24 months postoperation ( P ＞ 0.05).One patient in group B was found to have lost his fracture reduction and 3 patients were admitted to hospital for implant removal one year after operation. Conclusion In the treatment of type C3.1 fractures of distal radius,the volar approach plus locking plating (or with an additional auxiliary incision through the dorsal approach) can provide better fracture reduction and stabler fixation to reduce surgical complications than the dorsal approach plus locking plating.
