克氏针撬拔复位固定治疗34例桡骨远端骨折临床分析

Clinical analysis on percutaneous reduction fixation treatment of 34 cases of distal radius fracture with the intrafocal pinning

[背景]评价克氏针撬拔复位固定治疗桡骨远端骨折的疗效.[病例报告]给34例桡骨远端骨折患者实施克氏针撬拔复位固定术,用放射线检查方法检测患侧及健侧的桡骨关节面的掌倾角、尺倾角及桡骨短缩,并检测腕关节内旋外旋、背伸掌屈活动范围及握力,以Cooney的改良Mayo腕关节评分方法给予评分.患侧术前、术后、随访结果见尺倾角分别为19°,23°,22°(健侧为24°),掌倾角分别为9°,10°,8°(健侧为11°),桡骨短缩各为2,0,1 mm.平均6周后骨愈合.最终随访患侧腕关节内旋外旋活动消失角度各为1°,2°,屈曲伸展消失角度各为15°,10°,术后患侧握力平均为健侧的88%.改良Mayo腕关节评分平均为82分,优为6例,良为20例,尚可为8例;4例发生并发症,1例为桡神经浅支损伤,3例为浅表感染;未见畸形愈合及骨不连病例.[讨论]若无关节内骨折、背侧干骺端粉碎性骨折及无明显骨质疏松的桡骨远端骨折,用克氏针撬拔复位固定可取得满意的疗效.

BACKGROUNDTo evaluate the usefulness of treatment of the distal radius fracture by using intrafocal pinning technique.CASE REPORTSThirty four patients of distal radius fractures were treated by percutaneous reduction fixation with intrafocal pinning,and were estimated by simple radiographic findings（volar tilting,radial shortening and radial inclination by bilateral wrist PA and lateral X-ray）;physical examination（pronation and supination,dorsiflexion and palmar flexion and grip power） and clinical manifestation by Cooney＇s modified Mayo wrist scoring system.Average bone union at post operation 6 weeks,initial,postopertive,follow up radial inclination was 19°,23°,22°（normal wrists 24°）,Volar tilting was 9°,10°,8°（normal wrists 11°）,radial shortening was 2,0,1mm.Loss of pronation and supination averaged 1° and 2° compared with the uninjuried wrists.Loss of dorsiflexion and palmarflexion averaged 15° and 10°,and grip power averaged 88% compare the nonoperated side.The average modified Mayo wrist score is 82,exellent 6,good 20,fair 8.Complications included injury of radial sensory branch 1 patient,infection of superfical pin sites 3 patients,no malunion or nonuion.DISCUSSIONIntrafocal pinning provides an effective means to stabilize distal radius fractures,except for fractures extended intraarticular surface,with dorsal metaphyseal comminution and with severe osteoporosis.