CAJ | 학술논문

目的探讨桡骨远端Die-punch骨折的手术治疗效果.方法 2005年1月至2011年12月,对15例有移位和复位效果不满意的桡骨远端Die-punch骨折患者采用早期手术治疗.骨折均经X线片和CT确诊,包括:背侧型4例,掌侧型1例,劈裂型2例,塌陷型5例,劈裂加塌陷型3例;合并桡尺远侧关节分离3例,合并尺骨茎突骨折3例.除背侧型采取背侧切口外,其余均采取掌侧切口.本组采用2.4mm或2.7mm解剖钛板固定6例,3.5mm钢板固定3例,螺钉固定3例,克氏针固定1例,克氏针结合外固定支架固定2例.伴桡尺远侧关节分离3例中,复位后不稳定者1例予克氏针固定5周,2例行植骨.结果所有切口均Ⅰ期愈合,无神经血管损伤、内固定松动断裂和骨不连等并发症发生.15例均获得随访,时间9 ～ 28个月(平均13个月),其中1例复位不良者有轻度创伤性关节炎表现,腕关节功能按Sariento标准进行评定:优9例,良5例,可1例;优良率为93.3％.结论桡骨远端Die-punch骨折是一种较特殊的关节内骨折,有移位和复位效果不满意者早期手术治疗效果较佳.
목적 탐토뇨골원단Die-punch골절적수술치료효과.방법 2005년1월지2011년12월,대15례유이위화복위효과불만의적뇨골원단Die-punch골절환자채용조기수술치료.골절균경X선편화CT학진,포괄:배측형4례,장측형1례,벽렬형2례,탑함형5례,벽렬가탑함형3례;합병뇨척원측관절분리3례,합병척골경돌골절3례.제배측형채취배측절구외,기여균채취장측절구.본조채용2.4mm혹2.7mm해부태판고정6례,3.5mm강판고정3례,라정고정3례,극씨침고정1례,극씨침결합외고정지가고정2례.반뇨척원측관절분리3례중,복위후불은정자1례여극씨침고정5주,2례행식골.결과 소유절구균Ⅰ기유합,무신경혈관손상、내고정송동단렬화골불련등병발증발생.15례균획득수방,시간9 ～ 28개월(평균13개월),기중1례복위불량자유경도창상성관절염표현,완관절공능안Sariento표준진행평정:우9례,량5례,가1례;우량솔위93.3％.결론 뇨골원단Die-punch골절시일충교특수적관절내골절,유이위화복위효과불만의자조기수술치료효과교가.
Objective To explore the treatment outcomes of surgical management of die-punch fractures of the distal radius.Methods Fifteen cases of die-punch fractures of distal radius with displacement and unsatisfactory reduction were operated between January 2005 and December 2011.The fractures were confirmed by Ⅹ-ray and CT scans.There were 4 cases of dorsal fractures,1 case of volar fracture,2 cases of split fractures,5 cases of fracture collapse and 3 cases of split fractures associated with collapse.Of the 15 cases,3 cases were accompanied with distal radio-ulnar joint dissociation and 3 cases accompanied by ulnar styloid fracture.Volar surgical approach was taken for all the types except the dorsal fractures which were treated via dorsal approach.In this group,2.4 mm or 2.7 mm anatomical titanium plate was used in 6 cases,3.5 mm plate in 3 cases,screws in 3 cases,Kirschner wires in 1 case and Kirschner wires combined with external fixator in 2 cases.Of the 3 cases accompanied by distal radio-ulnar joint dissociation,one was still unstable after reduction and was fixed with Kirschner wire for 5 weeks.The other two had bone grafting.Results Primary healing of incisions was achieved in all the patients.There were no injuries to the nerves and vessels,no loosening or breakage of the implants and no fracture nonunion.All 15 cases were follow-up for 9 to 28 months with an average of 13 months.Mild traumatic arthritis of the wrist was seen in 1 case that had unsatisfactory fracture reduction.Wrist function was assessed according to Sarmiento scale and was rated as excellent in 9 cases,good in 5 cases and fair in 1 case,with an excellent and good rate of 93.3％.Conclsion Die-punch fracture of the distal radius is a special intra-articular fracture.Early surgical management should be conducted for cases with fracture displacement and unsatisfactory fracture reduction to obtain good results.