CAJ | 학술논문

目的：探讨取髂骨植骨术重建、修复桡骨远端关节面的疗效结果。方法2012年6月至2014年9月，应用外固定支架＋手术切开复位内固定术＋取髂骨植骨术治疗桡骨远端严重关节内粉碎骨折合并关节面缺损15例。结果术后14例X线片显示：关节面分离和错位＜1．0 mm 10例，＜2．0 mm 4例，掌倾角为0～15°，尺倾角20～30°，14例无骨短缩，骨折均全部愈合，临床愈合时间为10～16周。1例合并颅脑损伤患者因术后欠合作，强行活动腕关节及撞击外固定支架，造成支架松动，骨折复位丢失及骨折延迟愈合，虽经补救手术治疗，患者腕关节功能恢复欠佳。15例获得4～18个月随访，所有病例采用Gartland-Werley功能评分标准评估腕关节功能，优秀（0～2分）4例，良好（3～8分）7例，一般（9～14分）3例，差（≥15分）1例。结论该术式可以重建桡骨远端干骺端，可以解决桡骨远端关节面因骨质缺损带来的关节失稳的问题，并能挽救腕关节的部分运动功能，减少早期行桡腕关节融合术的几率，减少或减轻创伤性关节炎的发生。
목적：탐토취가골식골술중건、수복뇨골원단관절면적료효결과。방법2012년6월지2014년9월，응용외고정지가＋수술절개복위내고정술＋취가골식골술치료뇨골원단엄중관절내분쇄골절합병관절면결손15례。결과술후14례X선편현시：관절면분리화착위＜1．0 mm 10례，＜2．0 mm 4례，장경각위0～15°，척경각20～30°，14례무골단축，골절균전부유합，림상유합시간위10～16주。1례합병로뇌손상환자인술후흠합작，강행활동완관절급당격외고정지가，조성지가송동，골절복위주실급골절연지유합，수경보구수술치료，환자완관절공능회복흠가。15례획득4～18개월수방，소유병례채용Gartland-Werley공능평분표준평고완관절공능，우수（0～2분）4례，량호（3～8분）7례，일반（9～14분）3례，차（≥15분）1례。결론해술식가이중건뇨골원단간후단，가이해결뇨골원단관절면인골질결손대래적관절실은적문제，병능만구완관절적부분운동공능，감소조기행뇨완관절융합술적궤솔，감소혹감경창상성관절염적발생。
Objective To investigate the therapeutic effect of the iliac bone graft to reconstruct and repair the articular surface of the distal radius.Methods During June, 2012 to Sept.2014, application of external fixator and operation of open reduction an interal fixation and ilia bone grafting on the treament of distal radius comminuted intraarticular fractures with articular surface defect in 15 cases.Results After operation, 14 cases of X-ray flim showed the articular surface separation and dislocation <2.0mm in 4 cases, <1.0mm in 10 cases, palmar tilt to 0 to 15 degrees, ulna inclination 20 to 30 degrees, 14 cases without shortening of bone, fracture healing, healing time was 10 to 16 weeks. In 1 patients with craniocerebral injury patients for postoperative owe cooperation, forced wrist external fixator and impact, causing bracket loosening, loss of reduction and fracture healing fracture, although after the remedial operation treament, wrist jiont funtion recovery in patients with poor.All 15 cases were followed up for 4 to 18 months, all patients with Gartland-Werley funtioal score standard evaluation funtion of wrist jiont, excellent (0~2 score ) in 4 cases, Good (3~8 score ) in 7 cases, (9~14 score ) in 3cases, (more than 15score ) in 1 case.Conclusions This technique can reconstruct the radius distal metaphysis, can solve joint surface of the distal radius bone defect caused by instability of some movement, and can save the wrist joint, reduce early chances for radiocarpal fusion, reduce or mitigate the occurrence of traumatic arthritis.