CAJ | 학술논문

背景：桡骨远端不稳定性骨折是老年人群最常见的骨折之一，如何处理此类桡骨远端关节内骨折，目前学术界仍存在争议。 　　目的：观察闭合复位外固定支架修复桡骨远端AO C型骨折的临床效果、影像学结果和并发症。 　　方法：2009年5月至2012年5月采用闭合复位外固定支架修复桡骨远端AO C型骨折患者122例(122腕)，骨折根据AO分型：C1型16例，C2型63例，C3型43例。所有患者要求治疗后3，6，12周、1年、以后每年来院进行临床和影像学评估1次。采用改良McBride评分系统评定腕关节功能。同时记录手术时间、住院天数、骨折愈合时间、腕关节功能及并发症发生率。拍摄腕关节正侧位X射线片进行影像学评估，以观察掌倾角、尺偏角、桡骨高度及关节面台阶(根据Knirck等分类标准)。 　　结果与结论：122例患者均获随访，随访时间13-28个月。手术时间(19.1±11.2) min，透视时间(7.8±2.6) s，出血量(45.7±14.8) mL，住院天数(2.7±1.9) d，骨折愈合时间(3.1±0.7)个月。至末次随访时，改良 McBride评分为1-23分，平均6.7分，优良率62%；掌倾角10°-15°，平均(11.7±2.6)°；尺偏角18°-26°，平均(21.3±5.7)°；桡骨高度10-16 mm，平均(12.9±2.8) mm。关节面台阶根据Knirck等分类标准：1级108例；2级14例。共8例患者(6.6%)出现术后并发症，其中钉道感染6例，桡神经感觉支神经炎2例。提示采用闭合复位外固定支架治疗桡骨远端AO C型骨折创伤较小，住院天数较短，并发症轻微，骨折愈合较快，尤其适用于老年性桡骨远端AO C型骨折的修复。
배경：뇨골원단불은정성골절시노년인군최상견적골절지일，여하처리차류뇨골원단관절내골절，목전학술계잉존재쟁의。 　　목적：관찰폐합복위외고정지가수복뇨골원단AO C형골절적림상효과、영상학결과화병발증。 　　방법：2009년5월지2012년5월채용폐합복위외고정지가수복뇨골원단AO C형골절환자122례(122완)，골절근거AO분형：C1형16례，C2형63례，C3형43례。소유환자요구치료후3，6，12주、1년、이후매년래원진행림상화영상학평고1차。채용개량McBride평분계통평정완관절공능。동시기록수술시간、주원천수、골절유합시간、완관절공능급병발증발생솔。박섭완관절정측위X사선편진행영상학평고，이관찰장경각、척편각、뇨골고도급관절면태계(근거Knirck등분류표준)。 　　결과여결론：122례환자균획수방，수방시간13-28개월。수술시간(19.1±11.2) min，투시시간(7.8±2.6) s，출혈량(45.7±14.8) mL，주원천수(2.7±1.9) d，골절유합시간(3.1±0.7)개월。지말차수방시，개량 McBride평분위1-23분，평균6.7분，우량솔62%；장경각10°-15°，평균(11.7±2.6)°；척편각18°-26°，평균(21.3±5.7)°；뇨골고도10-16 mm，평균(12.9±2.8) mm。관절면태계근거Knirck등분류표준：1급108례；2급14례。공8례환자(6.6%)출현술후병발증，기중정도감염6례，뇨신경감각지신경염2례。제시채용폐합복위외고정지가치료뇨골원단AO C형골절창상교소，주원천수교단，병발증경미，골절유합교쾌，우기괄용우노년성뇨골원단AO C형골절적수복。
BACKGROUND:Unstable distal radius fracture is the most common fracture in the elderly patients, how to treat this kind of intra-articular distal radius fracture remains controversial. OBJECTIVE:To summarize the clinical, radiographic outcomes and complications of closed reduction and external fixation of the AO type C distal radial fracture. METHODS:From May 2009 to May 2012, we performed closed reduction and external fixation in 122 patients (122 wrists) with the AO type C distal radial fractures. According to AO fracture classification:C1 in 16 patients, C2 in 63 patients, and C3 in 43 patients. The study participants underwent clinical and radiographical evaluation at 3, 6, 12 weeks, and 1 year postoperatively and annual y thereafter. Wrist joint function of patients was anteroposterior and lateral X-ray films by palmar angulation, ulnar variance, radial height, and quality of articular reduction according to Knirck’s classification. RESULTS AND CONCLUSION:Al 122 patients were fol owed up for 13 to 28 months. The mean operative time was 19.1±11.2 minutes;the mean fluoroscopy time was 7.8±2.6 seconds;the mean bleeding loss was 45.7±14.8 mL;the mean length of hospital stay was 2.7±1.9 days;the mean union time was 3.1±0.7 months. At the final fol ow-up, the average modified McBride score was 6.7 points (range, 1 to 23 points), the rate of good to excel ent was 62%. The average palmar angulation was 11.7±2.6° (range, 10° to 15°). The average ulnar variance was 21.3±5.7° (range, 18° to 26°). The mean radial height was 12.9±2.8 mm (range, 10 to 16 mm). Quality of articular reduction based on Knirck and Jupiter’s classification shows Stage 1 in 108 patients and Stage 2 in 14 patients. Eight patients (6.6%) suffered from postoperative complications, including pin tract infection in six patients, sensory branch of the radial nerve neuritis in two patients. Results verified that closed reduction and external fixation of the AO type C distal radial fractures can achieve a satisfactory clinical function, has a less trauma, shorter hospital stay, lower rate of complications, faster fracture union, especial y is suitable for treatment of the AO type C distal radial fractures in the elderly.