CAJ | 학술논문

目的：研究桡骨颈骨折置入钛板时安全区位置和置入安全区方法，避免影响前臂旋转范围，减少对神经和血运损伤，最大程度恢复前臂功能。方法回顾性研究我院自2010年7月至2014年7月收治32例无合并伤的单纯桡骨颈骨折，其中男26例，女6例，年龄15~60岁，平均（35.4±0.5）岁。致伤原因：摔伤25例，车祸伤4例，高处坠落伤2例，打架伤1例。根据 Steele 和 Gtrham 方法把桡骨颈骨折的严重程度分为四级，本次研究病例中，其中2级24例，3级5例，4级3例。桡骨颈骨折均行钛板固定治疗，采取 Kocher 入路切开复位，术中采用前臂旋后法标记安全区后缘，然后旋前前臂，根据后缘预放置钛板，找到钛板固定位置，经该处切开关节囊，放置钛板固定，钛板长度不超过3 cm，术后行康复锻炼。根据 Steele 和 Gtrham 评价标准来评价结果。结果32例患者均获随访，随访时间12~24个月，平均16个月。结果示骨折愈合时间3~6个月，平均4个月。本组病例未发现感染、神经损伤，未发现桡骨头坏死和骨折不愈合病例。仅1例患者因术后恐惧疼痛，不行锻炼，制动时间较长，导致关节僵硬，后经康复治疗，功能好转，但仍部分受限。根据 Steele 和 Gtrham 评价标准进行评价，优27例，良4例，一般1例，优良率为96.8％。结论经该法切开复位钛板固定桡骨颈骨折，术后肘关节及前臂功能恢复良好。通过寻找安全区置入钛板，配合手术技巧减少神经和血运损伤，可最大程度恢复肘关节和前臂功能。
목적：연구뇨골경골절치입태판시안전구위치화치입안전구방법，피면영향전비선전범위，감소대신경화혈운손상，최대정도회복전비공능。방법회고성연구아원자2010년7월지2014년7월수치32례무합병상적단순뇨골경골절，기중남26례，녀6례，년령15~60세，평균（35.4±0.5）세。치상원인：솔상25례，차화상4례，고처추락상2례，타가상1례。근거 Steele 화 Gtrham 방법파뇨골경골절적엄중정도분위사급，본차연구병례중，기중2급24례，3급5례，4급3례。뇨골경골절균행태판고정치료，채취 Kocher 입로절개복위，술중채용전비선후법표기안전구후연，연후선전전비，근거후연예방치태판，조도태판고정위치，경해처절개관절낭，방치태판고정，태판장도불초과3 cm，술후행강복단련。근거 Steele 화 Gtrham 평개표준래평개결과。결과32례환자균획수방，수방시간12~24개월，평균16개월。결과시골절유합시간3~6개월，평균4개월。본조병례미발현감염、신경손상，미발현뇨골두배사화골절불유합병례。부1례환자인술후공구동통，불행단련，제동시간교장，도치관절강경，후경강복치료，공능호전，단잉부분수한。근거 Steele 화 Gtrham 평개표준진행평개，우27례，량4례，일반1례，우량솔위96.8％。결론경해법절개복위태판고정뇨골경골절，술후주관절급전비공능회복량호。통과심조안전구치입태판，배합수술기교감소신경화혈운손상，가최대정도회복주관절화전비공능。
Objective To study the position of the safety zone to put the titanium plate and placement methods,and avoid side effects on the forearm's rotating range and reducing damages of nerve and blood supply system,so as to realize maximum function recovery of the forearm. Methods 32 cases of simple radial neck fracture without collateral damages from July 2010 to July 2014 treated in my hospital was retrospectively studied,including 26 males and 6 females,aging from 15 years to 60 years old with the average age of 35. 4 ± 0. 5 years old. There were 25 cases caused by falling,4 cases by traffic accident,2 ca-ses by falling from high places,1 case by fight. According to Mr Steele and Gtrham's four severity scales of radial neck frac-ture,among the 32 cases in the study,level 2 group had 24 cases,level 3 group had 5 cases and level 4 group had 3 cases. Tita-nium plates were used in all 32 cases. Kocher method was adopted to perform the open reduction operation. Firstly,mark the posterior part of the safety zone by supinating the forearm and pronating the arm. Then,pre-place the titanium plate against the posterior part to find the fixating position of the titanium plate. And open the joint capsule to place the titanium plate no longer than 3 diameters. Post-operation recovery exercises were performed. The outcome was evaluated against the evaluation standards of Steele and Gtrham. Results All of 32 patients were followed up for 12 to 24 months with an average of 16 months. The re-sults showed that the fracture healing time was from 3 to 6 months,the average was 4 months. Among these cases,no infection or nerve injury was detected,and neither radial head necrosis nor nonunion was found. Only one patient refused to exercises due to fear of pain and resulted in a stiff joint. After rehabilitation therapy,function was partially recovered. According to the Steele and Gtrham's evaluation criteria,the excellent and good rate was 96. 8% . Conclusion Open reduction and titanium plate fixation can result in good recovery of the functions of elbow joint and forearm in treatment of radial neck fracture. Placing the titanium plate by finding the safety zone,together with operative techniques to reduce the damages to nerve and blood sup-ply system,can to the maximum extent recover the functions of the elbow joint and forearm.