CAJ | 학술논문

目的探讨腕关节镜辅助下治疗桡骨远端C型骨折的临床效果.方法对39例桡骨远端C型骨折患者,在腕关节镜监视下将桡骨远端骨折块进行手法复位结合撬拨复位,达到关节面基本平整,应用掌侧加压锁定钢板或克氏针加外固定支架固定.关节镜下进一步检查腕关节内韧带,特别是舟月韧带、月三角韧带和三角纤维软骨复合体(TFCC)的损伤,并对相应的软骨和韧带损伤进行清理、修整.结果 39例桡骨远端C型骨折,关节镜下发现骨折合并舟月韧带撕裂4例,合并月三角韧带撕裂3例,合并TFCC撕裂6例.术后全部患者获得6～24个月的随访,平均11.3个月,骨折全部愈合,愈合时间为8～ 16周,平均11.4周,术后测量掌倾角8°～17°,尺偏角16°～26°.腕关节功能按Gartland-Werley标准评定:优23例,良11例,可5例;优良率为87.2％.结论腕关节镜辅助下治疗桡骨远端C型骨折既可行关节面的复位,减少创伤性骨关节炎的发生,又可了解腕关节内韧带等结构的损伤程度,便于早期处理,以防遗留慢性腕关节疼痛或腕关节不稳定.
목적 탐토완관절경보조하치료뇨골원단C형골절적림상효과.방법 대39례뇨골원단C형골절환자,재완관절경감시하장뇨골원단골절괴진행수법복위결합효발복위,체도관절면기본평정,응용장측가압쇄정강판혹극씨침가외고정지가고정.관절경하진일보검사완관절내인대,특별시주월인대、월삼각인대화삼각섬유연골복합체(TFCC)적손상,병대상응적연골화인대손상진행청리、수정.결과 39례뇨골원단C형골절,관절경하발현골절합병주월인대시렬4례,합병월삼각인대시렬3례,합병TFCC시렬6례.술후전부환자획득6～24개월적수방,평균11.3개월,골절전부유합,유합시간위8～ 16주,평균11.4주,술후측량장경각8°～17°,척편각16°～26°.완관절공능안Gartland-Werley표준평정:우23례,량11례,가5례;우량솔위87.2％.결론 완관절경보조하치료뇨골원단C형골절기가행관절면적복위,감소창상성골관절염적발생,우가료해완관절내인대등결구적손상정도,편우조기처리,이방유류만성완관절동통혹완관절불은정.
Objective To explore the clinical efficacy of internal fixation with wrist arthroscope assistance in type C fractures of distal radius.Methods Thirty-nine patients with distal radius type C fractures were involved.Under the wrist arthroccope monitoring,the fracture fragments of the distal radius were manually reduced so the articular surface was smooth and the displacement was less than 2 mm.Then the volar locking compression plate or K-wire external fixator was applied to fix the radius.The wrist joint ligaments were further examined under the arthroscope especially paying attention to the scapholunate ligament,lunotriquetral ligament and triangular fibrocartilage complex (TFCC).The corresponding cartilage and ligament damage was debrided under the wrist arthroscopy.Results Among the 39 cases of distal radius type C fracture,there were 4 cases of scapholunate ligament tear,3 cases of lunotriquetral ligament tear and 6 cases of TFCC tear.Postoperative follow-up ranged from 6 to 24 months with an average time of 11.3 months.Complete union of the fracture was achieved in all the patients about 8 to 16 weeks postoperatively,with a mean healing time of 11.4 weeks.The volar tilt and ulnar inclination angles were 8° to 17° and 16° to 26° respectively.Wrist functions were evaluated according to the Gartland-Werley system and rated as excellent in 23 cases,good in 11 cases and fair in 5 cases,with a good and excellent rate of 87.2％.Conclusion Wrist arthroscope-assisted treatment of type C fractures of the distal radius can not only restore the articular surface and reduce the occurrence of traumatic osteoarthritis,but also allows visualization of damages of TFCC and intra-articular ligaments.This enables early treatment so chronic wrist pain or wrist joint instability can be avoided.