组合式外固定器结合内固定加植骨治疗桡骨远端粉碎骨折

Treatment of comminuted distal radius fractures by external fixator combined with internal fixation with K-wire and bone graft

目的探讨应用组合式外固定器结合内固定加植骨治疗桡骨远端关节内粉碎骨折的疗效。方法1999年9月-2005年4月,应用组合式外固定器结合克氏针内固定加植骨术治疗桡骨远端严重关节内粉碎骨折15例。结果术后15例X线片显示：关节面分离和错位＜1．0mm 9例,＜2．0mm 6例；掌倾角为0°～10°,尺倾角20°～30°,15例均无骨短缩。骨折均全部愈合,临床愈合时间为6～10周。13例获得8～18个月随访,2例失访,按Dienst功能评定标准评定：优6例,良8例,可1例。结论组合式外固定器结合内固定加植骨是治疗桡骨远端严重关节内粉碎骨折的有效方法。

Objective To study the characteristics of fracture displacement and the techniques of reduction and fixation for severely comminuted distal radius fractures, and evaluate the treatment outcome of using external fixator, Kirehner wire and bone graft. Methods From September 1999 to April 2005, 15 patients with severely comminuted distal radius fractures were treated by combined application of external fixator, Kirchner wire and bone graft. There were 11 males and 4 females. The ages of the patients ranged from 23 to 75 years （average ： 43 years）. All fractures were type Ⅲ, Ⅳ or type C3 according to Mayo or AO/ASIF classification. The interval from injury to operation was from 5 hours to 29 days （average： 11 day）. 11 Bone graft was used in 11 patients. Results Postoperative X-rays showed that step off or displacement of the joint surface was less than 1.0mm in 9 cases and less than 2.0mm in 6 cases. Palmar tilt was 0°～10°while ulnar inclination was 20°～ 30°. There was no bone shortening. All the fractures healed. The time of bone union was from 6 weeks to 10 weeks. 13 patients were followed-up for 8 to 18 months. The wrist joint function was evaluated by Dienst criteria. There were 6 cases graded as excellent, 8 cases as good, and 1 case as fair. Conclusion A combination of external fixator and internal fixation by Kirehner wire and bone graft is an effective way to treat severe comminuted distal radius fractures.