CAJ | 학술논문

目的探讨掌侧锁定加压钢板(locking compression plate,LCP)结合Kapandji技术治疗背侧不稳定桡骨远端关节内骨折的方法及疗效.方法背侧不稳定桡骨远端关节内骨折患者43例,男17例,女26例;年龄42～65岁,平均57岁.按AO/ASIF分型,C1型26例,C2型16例,C3型1例.采用掌侧LCP结合Kapandji技术进行治疗.在Stewart等改良的Sarmiento评分基础上再次进行改良,从掌倾角、尺偏角、桡骨短缩和关节面台阶方面对桡骨远端影像学进行评估;采用Gartland-Werley功能评分对腕关节功能进行评估.结果所有患者均获得随访,随访时间16～47个月,平均27个月.掌倾角由术前-19.3°±11.2°改善至术后8.1°±3.2°,尺偏角由术前-13.6°±4.1°改善至术后18.0°±8.2°,桡骨短缩由术前(6.2±2.8)mm改善至术后(0.2±0.2)mm,关节面塌陷由术前(5.5±4.3)mm改善至术后(0.1±0.2)mm.在Stewart等改良的Sarmiento评分基础匕再次进行改良的评分,优34例,良9例;Gartland-Werley功能评分,优18例,良22例,可3例.结论掌侧LCP结合Kapandji技术是治疗背侧不稳定桡骨远端关节内骨折的一种有效方法 ,可有效防止复位丢失、肌腱激惹等并发症,减少结构性植骨及行早期关节活动.
목적 탐토장측쇄정가압강판(locking compression plate,LCP)결합Kapandji기술치료배측불은정뇨골원단관절내골절적방법 급료효.방법 배측불은정뇨골원단관절내골절환자43례,남17례,녀26례;년령42～65세,평균57세.안AO/ASIF분형,C1형26례,C2형16례,C3형1례.채용장측LCP결합Kapandji기술진행치료.재Stewart등개량적Sarmiento평분기출상재차진행개량,종장경각、척편각、뇨골단축화관절면태계방면대뇨골원단영상학진행평고;채용Gartland-Werley공능평분대완관절공능진행평고.결과 소유환자균획득수방,수방시간16～47개월,평균27개월.장경각유술전-19.3°±11.2°개선지술후8.1°±3.2°,척편각유술전-13.6°±4.1°개선지술후18.0°±8.2°,뇨골단축유술전(6.2±2.8)mm개선지술후(0.2±0.2)mm,관절면탑함유술전(5.5±4.3)mm개선지술후(0.1±0.2)mm.재Stewart등개량적Sarmiento평분기출비재차진행개량적평분,우34례,량9례;Gartland-Werley공능평분,우18례,량22례,가3례.결론 장측LCP결합Kapandji기술시치료배측불은정뇨골원단관절내골절적일충유효방법 ,가유효방지복위주실、기건격야등병발증,감소결구성식골급행조기관절활동.
Objective To explore the method and evaluate the effect of volar LCP fixation combined with Kapandji technique for dorsal unstable inter-articular distal radial fractures.nethods Forty-three patients(male 17 and female 26,aged 42 to 65 years with the mean of 57 years)with dorsal unstable inter-articular distal radial fractures were treated with volar LCP combined with Kapandij techniques.There were 26 cases for fype C1,16 cases for type C2 and 1 case for tvpe C3 according to AO/ASIF classification criteria of fractures.To modify again Sarmiento scale(modified by Stewart first),and the parameters of imageology of the fractures were estimated,while the wrist function through Gartland-Werley functional assessment system.The effects were evaluated through comparing the volar tilt.radial inclination,articular set-off,radial shortening and wrist funetion.Results All the patients were followed up from 16 to 47 months (average 27 months)postoperatively,and the volar tilt increased from -19.3°±11.2° to 8.1°±3.2°,radial inclination increased from -13.6°±4.1° to 18.0°±8.2°,the radial shortening decreased from(6.2±2.8)mm to(0.2±0.2)mm,and articular set-off decreased from(5.5±4.3)mm to(0.1±0.2)mm.Postoperatively,34 patients achieved excellent and 9 good according to the twice modified Sarmiento scale io the radiologieal manifestation and 18 patients displayed excellent and 22 good with 3 fair according to Gartland-Werley functional assessment system.Conclusion Volar LCP fixation comlfined with Kapandji technique is a safe and effective method for treating the unstable distal radial fractures of type C,which can prevent reduction lost,reduce need for hone grafting.provide for early Wrist motion and avoid tendon irritation.