桡骨远端骨折类型与内外固定植入体、人工假体及其骨替代物的关系

Distal radius fracture associated with internal and external fixation implant,artificial prosthesis and bone substitute

学术背景:随着桡骨远端骨折三柱理论的提出,以及各种固定材料不断的出现,桡骨远端骨折治疗中应用内外固定植入体、人工假体、骨替代物的相关研究已成为热点。目的:通过对各种植入体、植入材料的比较选择,进一步认识如何用最简单、最安全的方法处理桡骨远端骨折,使每一位患者、每一种骨折类型能够达到微创、解剖复位、相对稳定的最佳效果。检索策略:应用计算机检索PubMed 1990-01/2006-12相关的文献,检索词"distalradius,fracture,treatment",限定文献语言种类为English。检索到临床观察及基础研究文章882篇,综述类文章159篇。对资料进行初审,纳入文献标准为与桡骨远端骨折治疗上相关的临床观察及基础研究文章169篇,选取针对性强的文章,同一领域的文献则选择近期发表或权威杂志的文章。排除非相关文献及综述872篇。未发表的文献均未列入统计。文献评价:对所得文献进行提炼,按上述标准纳入31篇。资料综合:①石膏、夹板外固定曾经一直是桡骨远端骨折治疗的标准方法。②近年来,随着腕部生物力学及显微解剖学的发展,以及对桡骨远端骨折复位与重建要求的提高,桡骨远端骨折的治疗观念不断更新,不同类型的桡骨远端骨折出现了不同的治疗方法。③经皮穿针复位内固定植入体主要适用于关节外骨折。④外固定支架是治疗桡骨远端骨折的有效方法之一,尤其是桡骨短缩畸形可以通过外固定支架得到矫正。⑤桡骨远端骨折切开复位内固定置入技术的发展主要是由内固定材料设计上的改进及手术入路的选择所引起的。⑥人工腕关节逐渐被应用于临床,为因腕关节严重创伤、关节僵硬和严重创伤性关节炎的患者提供了一个可供选择的新方法。⑦桡骨远端骨折常存在干骺端骨缺损,尤其是老年骨质疏松明显的患者,治疗时常需要进行骨或骨替代物移植,可注射的磷酸钙骨水泥是治疗桡骨远端骨折的一个新选择。结论:任何一种单独的方法都不能处理全部的桡骨远端骨折,对每一位患者、每一种骨折类型,应制定个体化的治疗方案,选择适合的植入物及植入材料,采用多种联合的治疗方法。

BACKGROUND： The introduction of distal radius fracture theory and the appearance of various fixation materials make the research on the internal and external fixation implant, artificial prosthesis and bone substitute employed in treating distal radius fracture become a hot spot. OBJECTIVE： Through the comparison and selection among various implants and implantation materials, to further confirm how to treat distal radius fracture simply and safely, so as to achieve the best curative effect of minimal invasive, anatomy reposition and stability in every patient and every kind of fracture. RETRIEVAL STRATEGY： A computer-based online search of PubMed was undertaken for the English articles dated from January 1990 to December 2006 with the keywords of ＂distal radius, fracture, treatment＂. 882 articles of clinical observation and basic research, and 159 review articles were collected. After the first trial, 169 articles involved the clinical observation of treatment of distal radius fracture were selected. The articles directly aiming at the objective and published in authoritative journals recently in the same field were also involved. 872 non-relative articles and review articles were excluded. Articles not published were not included. LITERATURE EVALUATION： The selected articles were refined and finally 31 were included. DATA SYNTHESIS： ①Plaster stone and splint external fixation have been the standard methods for treating distal radius fracture. ②Recently, with the development of wrist biology and microscope anatomy and the improvement in the reposition and reconstruction of distal radius fracture, the treatment concept of distal radius fracture is renewing. Different therapies are applied in various types of distal radius fracture. ③Percutaneous transfixation-pin internal fixation implant is mainly used for extra-articular fracture. ④External fixation scaffold is one of the effective therapies for distal radius fracture, especially for radial crispation deformity. ⑤The improvement in the internal material design and selection of operative approach bring an development of open reduction and internal fixation of distal radius fracture. ⑥Artificial joint for wrist is gradually applied in clinic, and provides an alternation for patients with severe wound of wrist joint, anchylosis and severe traumatic arthritis. ⑦Metaphysial bone defect is always found in distal radius fracture, especially in elder patients with osteoporosis. Bone or bone substitute transplantation is a common therapy. Injectable calcium bone cement is a new selection for treating distal radius fracture. CONCLUSION： Any single therapy could not treat all sorts of distal radius fracture. Therefore, it is better to institute individualized therapy, select suitable implant or implantation material and integrate various therapies for each patient and each kind of fracture.