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桡骨远端B3型不稳定骨折T形钢板手术治疗探讨

CLINICAL EVALUATION OF SURGICAL TREATMENT OF B3-TYPE INSTABLE FRACTURE OF DISTAL RADIUS WITH T-SHAPE PLATE
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摘要 [目的]探讨桡骨远端B3型不稳定骨折T形钢板固定的手术治疗效果,以及在解剖复位、固定、尽早功能训练、恢复腕关节功能、降低创伤性关节炎发生率等方面的作用。[方法]本组35例术前拍双侧腕关节正侧位X片。取远端掌侧切口入路,在保护周围的软组织、骨折块血运、减少支持韧带破坏的基础上复位。术中拍片,了解关节面复位的情况。T型钢板螺钉固定于桡骨远端的掌侧面,桡骨远端压缩塌陷严重者,同时植骨。术后不用外固定,早期活动腕关节,有利于关节功能的恢复。[结果]随访10个月~18年,平均10年。根据改良MCbride评分和纽约骨科医院腕关节评估标准分为优、良、可、差4级[1]。其中优25例(71.14%)、良7例(20.00%),可2例(5.71%)、差1例(3.15%)。优良率达91.14%明显优于保守治疗的效果。[结论]桡骨远端B3型不稳定骨折应采取较积极的态度,尽早手术对骨折移位的关节面进行解剖复位[2,3],尽早开始功能训练,可以获得好的关节功能。 [Objective] To evaluate the surgical treatment effects of B3-type instable fracture of distal radius with T-shape plate and its contribution to surgical reduction, fixation, early rehabilitation training, restoration of wrist function and lowering incidence of traumatic arthritis. [Methods] There were 35 cases. Preoperative AP and lateral X-ray film including bilateral wrist of them were obtained. Considering the preservation of blood supply of soft tissue and fracture fragments, minimal destruction of flexor retinaculum, surgical reduction was operated in palm side incision of distal radius. During operation, radiographs were taken to evaluate the reduction of joint surface. T-shape plate and screw were fixed at palmar of distal radius and bone grafting was additionally applied in cases with eomminuted fracture of distal radius. Early rehabilitation training of wrist joint was suggested to help restore its function without post-operative extemal fixation[Results]The average follow-up time was 10 years (10 months-18 years) . According to modified MCbride assessment system and function assessment standard of wrist joint from Orthopedics Hospital of New York, there are 4 grades including excellent, good, fair and poor. Of the cases, there were 25 (71.14%) excellent cases, 7 (20.00%) good cases, 2 (5.71%) faircases, and 1 (3.15%) poor cases. The rate of excellent-good was 91,14%, which showed that the effects of surgical treatment was better than conservative treatment. [Conclusions] B3-type instable fracture of distal radius must be treated actively. Early operation, anatomic reduction of joint surface and early rehabilitation training can be benefit for getting excellent joint function.
出处 《现代预防医学》 CAS 北大核心 2007年第16期3192-3193,3196,共3页 Modern Preventive Medicine
关键词 桡骨远端 B3型骨折 T形钢板 手术治疗 Distal third of radius B3-type fracture T-shape plate Surgical treatment
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参考文献8

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