摘要
背景：桡骨远端关节面掌侧缘骨折合并桡腕关节掌侧半脱位（Barton骨折）已普遍被人们所认识，且有大量的资料指导其治疗。而桡骨远端关节面背侧缘骨折合并桡腕关节背侧半脱位（有时称其为背侧或反Barton骨折）很少被提及，且指导其治疗的资料非常少。
方法：评估20例桡骨远端关节面背侧缘骨折合并桡腕关节背侧半脱位的患者，其中2例伴掌侧韧带撕裂；10例伴掌侧缘唇部骨折，有移位及旋转；6例伴关节面掌侧部分嵌插；2例无掌侧损伤。20例中14例关节面中央有碎骨片嵌入。18例患者采用不同的手术入路行背侧支撑钢板重建关节面。在随访时利用X线检查、改良的Mayo腕评分以及臂、肩及手伤残（DASH）问卷评估结果。
结果：在术后平均30个月时，19例骨折愈合且没有明显的对线不良，1例患者在取出钢板后再度出现背侧半脱位。腕和前臂最后的平均活动度为：掌曲59°，背伸56°，旋前87°旋后85°。平均握力为健侧的85％。根据Garfland和Werley的评定方法，最终的功能结果为：优、良18例，可2例。改良Mayo腕评分为平均75分，DASH评分为平均15分。
结论：桡骨远端关节面背侧缘骨折合并桡腕关节背侧半脱位伴系列掌侧损伤，包括韧带损伤、撕脱骨折和关节面嵌插。虽然这些损伤比较复杂，但手术治疗可使大多数患者获得满意的腕关节功能。
可信水平：治疗性研究，Ⅳ级。进一步可信度参见作者介绍。
Background： Fractures of the volar articular margin of the distal part of the radius with volar radiocarpal subluxation （Barton fractures） are well recognized, and substantial data are available to guide their treatment. In contrast, fractures of the dorsal articular margin of the distal part of the radius with dorsal radiocarpal subluxation （sometimes referred to as dorsal or reverse Barton fractures） are rarely mentioned, and there are very little data to guide their treatment.
Methods： Twenty patients with a fracture of the dorsal articular margin of the distal part of the radius with dorsal radiocarpal subluxation were evaluated. A spectrum of volar injuries was observed： two patients had torn volar ligaments; ten had a displaced, rotated volar marginal lip fracture; six had impaction of the volar aspect of the articular surface; and two had no appreciable volar injury. Fourteen of the twenty patients also had impacted central articular fragments. Eighteen patients underwent surgical reconstruction of the articular surface and application of dorsal buttress plates with use of a variety of surgical approaches. At the time of follow-up, the outcome was assessed radiographically and with use of the modified Mayo wrist score and the Disabilities of the Arm, Shoulder and Hand （DASH） questionnaire.
Results： At an average of thirty months postoperatively, nineteen fractures had healed without substantial loss of alignment and one patient had recurrent dorsal subluxation after plate removal. The final average amount of wrist and forearm motion was 59° of flexion, 56° of extension, 87° of pronation, and 85° of supination. The average grip strength was 85% of that of the contralateral, uninjured hand. The final functional result according to the system of Gartland and Werley was rated as excellent or good for eighteen patients and as fair for two. The average modified Mayo wrist score was 75 points, and the average DASH score was 15 points.
Conclusions： Fractures of the dorsal articular margin of the distal part of the radius with dorsal radiocarpal subluxation are accompanied by a spectrum of volar injuries, including ligament injuries, avulsion fractures, and impaction of the articular surface. Despite the relative complexity of these injuries, satisfactory wrist function can be achieved with operative treatment in most patients.
Level of Evidence： Therapeutic Level Ⅳ. See Instructions to Authors for a complete description of levels of evidence
