CAJ | 학술논문

背景:近年来桡骨远端掌侧(DVR)解剖锁定接骨板广泛应用于桡骨远端骨折的治疗,尤其是桡骨远端骨质疏松性骨折.目的:评价DVR解剖锁定接骨板治疗桡骨远端骨质疏松性骨折的临床疗效.方法:2009年5月至2011年12月共收治桡骨远端骨折87例,确诊为桡骨远端骨质疏松性骨折的29例行DVR解剖锁定接骨板掌侧入路固定.男11例,女18例;年龄56-78岁,平均63岁;骨折按AO分型:A2型3例,A3型6例,B1型1例,B3型2例,C1型6例,C2型7例,C3型4例;受伤距手术时间为1~12 d,平均5 d.结果:术后伤口均一期愈合,无一例出现术后感染.29例中21例获得随访,随访时间为12~20个月,平均14个月.影像学检查示均达到骨性愈合,愈合时间为12~18周,平均15周.末次随访时患者腕关节活动度:背伸41°~68°,平均52°;掌屈45°~78°,平均57°;旋前63°~86°,平均77°;旋后57°~80°,平均74°.末次随访采用Sarmiento改良Gart-land&Werley评分方法:优13例,良6例,可2例,差0例;腕关节VAS评分:腕关节完全无痛18例,轻度疼痛2例(评分为2分和2.5分),中度疼痛1例(评分为4分).无一例出现肌腱激惹;正中神经卡压1例,骨折愈合后6个月取出内固定并行松解术后症状完全消失;骨折背侧骨片移位1例,未对腕关节功能产生影响遂未予以处理.在背伸、掌屈、旋前、旋后4个方向的活动度比较,A型与B型骨折比较无统计学差异;A型与C型,B型与C型比较均存在统计学差异.结论:DVR解剖锁定接骨板板治疗桡骨远端骨质疏松性骨折可以获得良好的功能转归,C型骨折较A、B型骨折对腕关节活动影响更大.
배경:근년래뇨골원단장측(DVR)해부쇄정접골판엄범응용우뇨골원단골절적치료,우기시뇨골원단골질소송성골절.목적:평개DVR해부쇄정접골판치료뇨골원단골질소송성골절적림상료효.방법:2009년5월지2011년12월공수치뇨골원단골절87례,학진위뇨골원단골질소송성골절적29례행DVR해부쇄정접골판장측입로고정.남11례,녀18례;년령56-78세,평균63세;골절안AO분형:A2형3례,A3형6례,B1형1례,B3형2례,C1형6례,C2형7례,C3형4례;수상거수술시간위1~12 d,평균5 d.결과:술후상구균일기유합,무일례출현술후감염.29례중21례획득수방,수방시간위12~20개월,평균14개월.영상학검사시균체도골성유합,유합시간위12~18주,평균15주.말차수방시환자완관절활동도:배신41°~68°,평균52°;장굴45°~78°,평균57°;선전63°~86°,평균77°;선후57°~80°,평균74°.말차수방채용Sarmiento개량Gart-land&Werley평분방법:우13례,량6례,가2례,차0례;완관절VAS평분:완관절완전무통18례,경도동통2례(평분위2분화2.5분),중도동통1례(평분위4분).무일례출현기건격야;정중신경잡압1례,골절유합후6개월취출내고정병행송해술후증상완전소실;골절배측골편이위1례,미대완관절공능산생영향수미여이처리.재배신、장굴、선전、선후4개방향적활동도비교,A형여B형골절비교무통계학차이;A형여C형,B형여C형비교균존재통계학차이.결론:DVR해부쇄정접골판판치료뇨골원단골질소송성골절가이획득량호적공능전귀,C형골절교A、B형골절대완관절활동영향경대.
@@@@Background:In recent years, DVR anatomic locking plates has been widely used in treating distal radius fractures, especially the osteoporotic distal radial fractures. Objective:To evaluate the clinical effects of DVR anatomic locking plates in treating the osteoporotic distal radial fractures. Methods:From May 2009 to December2011, 29 out of 87 patients with distal radius fractures were diagnosed with osteopo-rosis and received the DVR treatment from volar approach. 11 were males and 18 were females. The average age was 63 years old (45-78 years old). According to AO classification system, there were 3 fractures of A2 type;6 of A3 type;1 frac-ture of B1 type, 2 of B3 type;6 of C1 type, 7 of C2 type and 4 of C3 type. The surgery was performed with an average of 5 days (1-12 days) after the injury. Results:All cases were healed by first intention, and no postoperative infection occurred. 21 out of 29 patients were followed up for an average period of 14 months (12~20 months). The image examination results showed that all patients achieved bone union after an average period of 15 weeks (12~18 weeks). At the last follow-up, the average ROM (range of motion) of the wrist joints were 52°(41°-68°), 57°(45°-78°), 77°(63°-86°), 74°(57°-80°) for dorsiflexion, palmer flexion, pronation and supi-nation respectively. According to Gartland&Werley Scores modified by Sarmiento, there were 13 excellent cases, 6 good, 2 fair and 0 poor;Evaluated by VAS score system, 18 cases were painless, 2 were of mild pain (scored 2 and 2.5 respectively) and 1 was of moderate pain (scored 4) at the last follow-up. There was no tendon irritation or rupture, but one case of median nerve irritation and another case of bone fracture displaced on dorsal side. The syndrome of median nerve irritation disap-peared after removing the interior fixation and a decompression surgery performed six months after the fracture was healed. For the syndrome of bone fracture displaced on dorsal side, since it has no impact on wrist function, no actions were taken to deal with it. As for the comparison of ROM of dorsiflexion, palmer flexion, pronation and supination, there were statistical differences between A type and C type, B type and C type, but no statistical difference between A type and B type. Conclusions:Treating osteoporotic distal radius fractures with DVR anatomic locking plates can achieve satisfactory func-tional recovery. C type fracture has more impact on wrist function compared to A type and B type fractures.