CAJ | 학술논문

目的探讨可调式锁定接骨板治疗桡骨远端骨折畸形愈合的临床疗效.方法回顾性分析2010年5月至2012年3月,采用可调式锁定接骨板治疗11例骨折畸形愈合患者资料,男3例,女8例;年龄35 ～ 76岁,平均(62.5±12.3)岁;左侧4例,右侧7例.其中2例为夹板固定治疗后致畸形愈合,2例为石膏固定治疗后致畸形愈合,1例为外固定治疗后致畸形愈合,6例为切开复位钢板内固定治疗后致畸形愈合;初次手术至再手术时间为5～20个月,平均(13.9±5.6)个月.根据影像学(包括尺骨变异、掌倾角、尺偏角)表现及握力、腕关节关节活动度、疼痛视觉模拟评分(visual analogue scale,VAS)、上肢功能(disability of arm shoulder and hand,DASH)调查表评价术后疗效.结果 11例患者均获得完整随访,随访时间10 ～ 15个月,平均12个月;影像学骨折愈合时间为7～12周,平均8周.术后12个月腕关节屈曲活动度为50.2°±11.3°(范围,35°～70°),背伸为55.1°±11.5°(范围,30°～80°),尺偏为30.1°±9.2°(范围,10°～40°),桡偏为22.1°±6.6°(范围,10°～ 30°),旋前为79.9°±8.5°(范围,60°～90°),旋后为82.6°±11.2°(范围,50°～90°);术后12个月DASH评分为平均(18.5±8.3)分(范围,10～35分),较术前平均(52.7±11.3)分有明显改善;术后VAS评分为平均(1.7±1.2)分(范围,0～4分),较术前平均(5.9±1.4)分明显改善.2例患者术后腕关节功能轻度受限,其中l例患者在重体力工作时有中度疼痛,但在内固定取出后症状改善;另1例患者经消炎镇痛药物治疗后症状改善.无一例发生继发移位、内置物松动及软组织感染.结论可调式锁定接骨板作为一种全新的钢板可以用于治疗桡骨远端骨折畸形愈合,术后患者腕关节解剖结构得以重建,关节功能获得改善.
목적 탐토가조식쇄정접골판치료뇨골원단골절기형유합적림상료효.방법 회고성분석2010년5월지2012년3월,채용가조식쇄정접골판치료11례골절기형유합환자자료,남3례,녀8례;년령35 ～ 76세,평균(62.5±12.3)세;좌측4례,우측7례.기중2례위협판고정치료후치기형유합,2례위석고고정치료후치기형유합,1례위외고정치료후치기형유합,6례위절개복위강판내고정치료후치기형유합;초차수술지재수술시간위5～20개월,평균(13.9±5.6)개월.근거영상학(포괄척골변이、장경각、척편각)표현급악력、완관절관절활동도、동통시각모의평분(visual analogue scale,VAS)、상지공능(disability of arm shoulder and hand,DASH)조사표평개술후료효.결과 11례환자균획득완정수방,수방시간10 ～ 15개월,평균12개월;영상학골절유합시간위7～12주,평균8주.술후12개월완관절굴곡활동도위50.2°±11.3°(범위,35°～70°),배신위55.1°±11.5°(범위,30°～80°),척편위30.1°±9.2°(범위,10°～40°),뇨편위22.1°±6.6°(범위,10°～ 30°),선전위79.9°±8.5°(범위,60°～90°),선후위82.6°±11.2°(범위,50°～90°);술후12개월DASH평분위평균(18.5±8.3)분(범위,10～35분),교술전평균(52.7±11.3)분유명현개선;술후VAS평분위평균(1.7±1.2)분(범위,0～4분),교술전평균(5.9±1.4)분명현개선.2례환자술후완관절공능경도수한,기중l례환자재중체력공작시유중도동통,단재내고정취출후증상개선;령1례환자경소염진통약물치료후증상개선.무일례발생계발이위、내치물송동급연조직감염.결론 가조식쇄정접골판작위일충전신적강판가이용우치료뇨골원단골절기형유합,술후환자완관절해부결구득이중건,관절공능획득개선.
Objective To detective the clinical effect of a special palmar fixed-angle plate on malunion in distal radius fracture.Methods We reviewed retrospectively 11 patients withmalunions in distal radius fracture who admitted to the hospital from May 2010 to March 2012.Among them,there were 3 males and 8 females,with an average age of 62.5±12.3 years old (range,35-76 years old).According to the treatment,2 got splintage,2 got plaster fixation,1 got external fixation and 6 got internal fixation.The time from initial fixation to the osteotomy was 5-20 months (average 13.9±5.6 months).During last follow-up,radiological results (radial length,ulna variance) and functional results (range of movement,and grip strength,VAS scores,DASH scores) were assessed.Results After patients got followed up of 12 months and recovered,the radiological and functional results improved with no secondary displacement,and no superficial or deep infection.All fractures united radiologically about 8 (range,7-12) weeks with low pain scores,good wrist function and grip strength.At the last follow-up (12 month),the excellent average motion was extension 55.1°± 11.5° (range,30°-80°),flexion 50.2°± 11.3° (range,35°-70°),supination 82.6°± 11.2° (range,50°-90°) and pronation 79.9°±8.5° (range,60°-90°).Of the 2 patients with low functional restriction,one patient had mild pain during heavy work and improved after the plate was removed,and the other one got better after the use of anti-inflammatory analgesic drugs.The DASH disability/symptom score and VAS score averaged 18.5±8.3 (range,10-35)and 1.7±1.2 (range,0-4) in our series,represent high levels of satisfaction.Conclusion The new special palmar fixed-angle plate was preferred for malunion in distal radius fractures to reconstruct the articular anatomy and improve the function of the wrist.