外固定加有限内固定治疗桡骨远端粉碎性骨折

Treatment of serious comminuted distal radius fractures by external fixator combined with limited internal fixation

目的探讨外固定架结合有限内固定治疗桡骨远端粉碎性骨折的临床疗效。方法自2001年1月至2004年5月采用外固定架加有限内固定治疗桡骨远端粉碎性骨折35例。男16例,女19例;年龄21～75岁,平均47.3岁。按AO/ASIF分型:A3型9例,C2型9例,C3型17例。开放性骨折4例,但皮肤及软组织损伤较轻,污染轻。手术方法中单纯手法牵引复位加外固定架27例,经皮钢针撬拨复位加外固定架5例,尺骨固定加外固定架3例。受伤至手术时间为0.5h～21d,平均6.6d(2例陈旧性骨折除外)。结果术后随访5～30个月,平均12个月。按照解剖学上的恢复结果,解剖复位9例、功能复位24例、接近功能复位2例。术前尺偏角为-15°～15°(平均10.5°)及掌倾角-30°～0°(平均-10°),术后尺偏角20°～35°(平均25°)及掌倾角0°～20°(平均11.5°)。关节功能疗效按Dienst功能评估标准进行评定:优12例、良21例、可2例。无针道感染,无针孔骨折,无医原性神经、血管损伤,无伤口感染及骨髓炎等并发症。结论外固定架结合有限内固定是治疗桡骨远端粉碎性骨折的一种较好的方法,其操作简单、固定可靠、疗效满意、并发症少。为桡骨远端骨折的治疗提供一种能明显促进骨折愈合、减少术后感染的新思路。

Objective To discuss the clinical effects of external fixator combined with limited internal fixation in treatment of serious comminuted distal radius fractures. Methods 35 patients with serious comminuted distal radius fractures were treated by external fixator combined with limited internal fixation from January 2001 to May 2004. There were 16 males and 9 females with an average age of 47.3 years. According to AO/ASIF classification, 9 fractures were A3 type, 9 C2, and 17 C3. Reduction was achieved and maintained in 27 cases by longitudinal traction and external fixation, 5 by external fixator with percutaneous K-wire, and 3 by external fixatator combined with ulnar limited internal fixation. Results All the patients were followed up from 5 months to 30 months (12 months on average). According to the anatomical alignment, 9 were excellent, 24 good, and 2 fair. It was necessary to restore the anatomy of distal radius both on sagittal and coronal planes in order to obtain good functions. Preoperatively, the radial inclination angle was -15° to 15°(10.5° on average), and the palmar tilt angle was -30° to 0°(-10° on average). After operation, the two angels were reduced to 20° to 35°(25° on average), and 0° to 20°(11.5° on average)respectively. The joint function was assessed by Dienst criteria, the results suggested that 12 were graded as excellent, 21 good, and 2 fair. No severe complications were found. Conclusion The treatment of serious comminuted distal radius fractures using external fixator combined with limited internal fixation is of easy performance, reliable fixation, satisfactory effect, and lower complications. It offers a new method which can obviously improve the union of the fractures and decrease the infection rate postoperatively for the treatment of the fractures of distal radius.