中华创伤杂志
中華創傷雜誌
중화창상잡지
Chinese Journal of Traumatology
2011年
9期
793-796
,共4页
费俊梁%蒋纯志%王黎明%梁斌
費俊樑%蔣純誌%王黎明%樑斌
비준량%장순지%왕려명%량빈
桡骨骨折%骨移植%关节%骨折愈合
橈骨骨摺%骨移植%關節%骨摺愈閤
뇨골골절%골이식%관절%골절유합
Radius fractures%Bone transplantation%Joints%Fracture healing
目的 探讨采用结构性自体髂骨移植治疗高能量损伤所致伴有关节面的塌陷与干骺端粉碎缺损的桡骨远端骨折的疗效。 方法 选取2007年1月-2010年10月就诊的桡骨远端骨折(AO分类C3型)患者38例，克氏针临时维持固定，使桡腕关节面、桡骨远端长度、掌倾角最大限度恢复。根据骨缺损的形态，取自体3层皮质骨髂骨块嵌入软骨下骨支撑植骨，并取少量松质骨植骨填塞顶压塌陷关节面，尽可能使关节面解剖复位，重建桡骨远端解剖形态。采用改良Gartland和Werley评分标准评定腕关节功能恢复情况。 结果 随访12～ 38个月，无钢板断裂和医源性神经血管损伤。本组骨折愈合时间15～22周，平均18.3周。部分患者经功能康复锻炼后腕关节功能明显改善。按改良Garland和Werley功能评估系统进行疗效评定，优良率为87％。随访中2例患者桡骨远端高度进行性丢失，2例患者桡腕关节面中央凹陷型塌陷，有严重的腕关节屈伸功能障碍。 结论高能量损伤所致复杂桡骨远端骨折需恢复桡腕关节面、桡骨远端长度、掌倾角，采用结构性自体髂骨移植能有效支撑植骨和维持桡腕关节面的平整，恢复桡骨远端的解剖形态，促进腕关节功能的恢复。
目的 探討採用結構性自體髂骨移植治療高能量損傷所緻伴有關節麵的塌陷與榦骺耑粉碎缺損的橈骨遠耑骨摺的療效。 方法 選取2007年1月-2010年10月就診的橈骨遠耑骨摺(AO分類C3型)患者38例，剋氏針臨時維持固定，使橈腕關節麵、橈骨遠耑長度、掌傾角最大限度恢複。根據骨缺損的形態，取自體3層皮質骨髂骨塊嵌入軟骨下骨支撐植骨，併取少量鬆質骨植骨填塞頂壓塌陷關節麵，儘可能使關節麵解剖複位，重建橈骨遠耑解剖形態。採用改良Gartland和Werley評分標準評定腕關節功能恢複情況。 結果 隨訪12～ 38箇月，無鋼闆斷裂和醫源性神經血管損傷。本組骨摺愈閤時間15～22週，平均18.3週。部分患者經功能康複鍛煉後腕關節功能明顯改善。按改良Garland和Werley功能評估繫統進行療效評定，優良率為87％。隨訪中2例患者橈骨遠耑高度進行性丟失，2例患者橈腕關節麵中央凹陷型塌陷，有嚴重的腕關節屈伸功能障礙。 結論高能量損傷所緻複雜橈骨遠耑骨摺需恢複橈腕關節麵、橈骨遠耑長度、掌傾角，採用結構性自體髂骨移植能有效支撐植骨和維持橈腕關節麵的平整，恢複橈骨遠耑的解剖形態，促進腕關節功能的恢複。
목적 탐토채용결구성자체가골이식치료고능량손상소치반유관절면적탑함여간후단분쇄결손적뇨골원단골절적료효。 방법 선취2007년1월-2010년10월취진적뇨골원단골절(AO분류C3형)환자38례，극씨침림시유지고정，사뇨완관절면、뇨골원단장도、장경각최대한도회복。근거골결손적형태，취자체3층피질골가골괴감입연골하골지탱식골，병취소량송질골식골전새정압탑함관절면，진가능사관절면해부복위，중건뇨골원단해부형태。채용개량Gartland화Werley평분표준평정완관절공능회복정황。 결과 수방12～ 38개월，무강판단렬화의원성신경혈관손상。본조골절유합시간15～22주，평균18.3주。부분환자경공능강복단련후완관절공능명현개선。안개량Garland화Werley공능평고계통진행료효평정，우량솔위87％。수방중2례환자뇨골원단고도진행성주실，2례환자뇨완관절면중앙요함형탑함，유엄중적완관절굴신공능장애。 결론고능량손상소치복잡뇨골원단골절수회복뇨완관절면、뇨골원단장도、장경각，채용결구성자체가골이식능유효지탱식골화유지뇨완관절면적평정，회복뇨골원단적해부형태，촉진완관절공능적회복。
Objective To investigate the curative effect of structural bone graft in treatment of high energy injury-induced complicated distal radius fractures combined with articular surface collapse and comminuted epiphyseal bone defect. Methods The study involved 38 patients with distal radius fractures (AO classification, type C3) treated from January 2007 to October 2010.The patients were treated with temporary Kirschner wire fixation to recover the wrist articular surface, distal radius length and palmar tilt angle at the greatest possibility.According to the form of the bone defects, the iliac bone taken from three layers of the cortical bone was embedded in the subchondral bone to support the bone graft, and a small amount of cancellous bone graft was collected to fill the articular surface collapse as much as possible for anatomical reduction of the articular surface, and anatomical form of the distal radius was reconstructed.Modified Sarmiento Gartland and Werley evaluation systems were used to evaluate the articular function recovery. Results The follow-up lasted for 1-3.2 years, which showed no complications such as plate rupture or iatrogenic nerve blood vessels injuries.The fracture healing time was 15-22 weeks (mean 18.3 weeks).The wrist articular function in some patients obtained obvious improvement through functional rehabilitation training.According to the modified Gartland and Werley function evaluation systems, the curative effects reached excellence rate of 87％.During follow-up, there were two patients with high progressive loss in the height of the distal radius and two with articular surface collapse and severe carpal joint flexion and extension dysfunction. Conclusions The high energy injury-induced distal radius fractures with articular surface collapse and epiphyseal bone defect need recovery of the wrist articular surface, distal radius length and palmar tilt angle.Structural bone graft can effectively support the grafted bone and maintain the flatness of the radiocarpal articular surface, restore the anatomy of the distal radius and facilitate the functional recovery of the wrist.
