T型锁定加压钢板内固定治疗桡骨远端合并干骺端及骨干粉碎性骨折的临床疗效

Clinical Efficacy of T-Locking Compression Plate Internal Fixation for the Treatment of Distal Radius Fractures with Metaphyseal and Diaphyseal Extension

目的探讨掌侧入路T型锁定加压钢板内固定治疗桡骨远端合并干骺端及骨干粉碎性骨折的临床疗效。方法 2007年5月~2012年5月,我院骨科采用掌侧入路T型锁定加压钢板内固定治疗桡骨远端合并干骺端及骨干粉碎性骨折40例,其中男16例,女24例,平均年龄43.5±7.3岁(25~74岁)。根据AO分类标准:A3型10例,C2型14例,C3型16例,均采用经掌侧入路,骨缺损严重者置入人工骨。结果所有患者均获随访,平均25个月(12~45个月),骨折平均愈合时间16周(10~28周)。根据Gratland-Werley功能评估标准进行评定:优32例,良5例,中2例,差1例,优良率达92.5%。1例患者术后出现正中神经麻痹但3个月后均自愈,1例患者出现下尺桡关节炎,2例患者出现关节间隙轻度狭窄但无腕关节功能障碍,未见骨感染、骨分离、内固定松动等并发症。结论掌侧入路T型锁定加压钢板内固定治疗桡骨远端合并干骺端及骨干粉碎性骨折的临床疗效确切,它可提供较好的轴向和角度稳定性并具有整体固定特点,有利于术后早期有效的功能锻炼,降低术后并发症的发生。

Objective The purpose of this study was to assess the radiographic and functional outcomes of treatment with the T-locking compression plate(T-LCP)system for distal radius fractures with metaphyseal and diaphyseal extension.Methods This retrospective study was performed between May 2007and June 2012,and 40consecutive patients underwent surgical treatment for a comminuted distal radial fracture that extended from the distal part of the radius to involve the diaphysis proximally with application of a T-LCP.There were 16males and 24females, average age was 43.5±7.3years(range,25~74years).Based with AO classification:10cases of type A3,14cases of type C2,and 16cases of type C3.All the cases were treated with open reduction and T-LCP fixation through volar approach.Results All the patients were followed up. The average follow-up period was 25months(range,12~45months).The average time to fracture union was 16weeks(range,10~28weeks). According to the Gartland-Werley demerit-point system:32Results were rated as excellent,5as good,2as fair,and 1as bad.The overall satisfactory rate was 92.5%.One patient had paresthesia in median nerve distribution without motor deficit.This symptom resolved spontaneously after 3months;one patient showed DRUJ arthritis;2wrists showed mild arthritic changes without restriction in daily activities;no patients showed infections,separation,internal fixation loosening and other complications.Conclusion Based on our experience,T-LCP is useful in the management of comminuted fractures of the distal radius,in which there is proximal extension into the diaphysis and can avoid or minimize the complications of external fixation or dorsal bridging distraction plate.