不同术式“个体化”治疗桡骨远端关节内骨折

Individual therapy for intra-articular fractures of the distal radius with different fixations

[目的]探讨桡骨远端关节内骨折的手术治疗方法及临床效果评价。[方法]对2005年3月-2007年9月通过手术治疗的56例桡骨远端关节内骨折病例进行回顾性分析。按AO原则分类，根据不同的骨折类型分别采用克氏针内固定、外固定支架、“T”形支撑钢板、背侧H形钢板及多种固定术式联合等方法。[结果]56例病人术后均获随访，随访时间6-36个月，平均14.6个月。复位质量按Aro等提出的测量方法评定：优35例，良17例，可3例，差1例，优良率92.9％。疗效按Dienst功能评定结果：优32例，良18例，可5例，差1例，优良率89.3％。平均DASH评分为17.7分，其中功能无受限38例，轻度受限15例，中度受限2例，重度受限1例。[结论]不同类型桡骨远端关节内骨折的患者应制定“个体化”的治疗方案。通过选择最适合的固定方法及配合术后合理的康复锻炼，能使腕关节功能达到最大的恢复。

[Objective] To evaluate the clinical outcome of surgical treatments of intra-articular fractures of the distal radius with different fixations. [Method]Fifty-six cases of intra-articular fractures of the distal radius were respectively operated upon from March 2005 to September 2007 with Kirshner＇wire, with external fixator, with T-shaped plate internal fixation, with dorsal Pishaped plate internal fixation or united fixation of more than two fixations according to the different types of fractures. There were 24 male and 32 female patients with an average age of 37 years （29-68years）. Twenty-one fractures were on the left side and 35 on the right side. The fractures were categorized according to the AO classification of distal radial fractures：6 of type B1,8 of type B2（dorsal Barton fracture）, 13 of type B3 （ volar Barton fracture）, 5 of type C1,13 of type C2,11 of type C3, and 3 of open frac-tures included 2 of Gustilo type Ⅱ and 1 of Gustilo type ⅢA. Five were treated with Kirshner＇wire,9 with open reduction and T-shaped plate intemal fixation,9 with closed reduction and external fixator,8 with T-shaped plate internal fixation ＋ external fixator, 12 with Kirshner＇wire ＋ external fixator,2 with Kirshner＇wire ＋ T-shaped plate internal fixation ＋ external fixator, 11 with dorsal Pi-shaped plate internal fixation. Six patients underwent bone graft （4 at stage I and 2 at stage Ⅱ）. [Result] All 56 patients were followed-up regularly. According to Aro＇reduction quality evaluation, the patients were graded as excellent in 62.5% （n=35） , good in 30.4% （n=7） , fair in 5.4% （n = 3） , poor in 1.8% （n = 1）. The good to excellent rate was 92.9% ;Dienst scale：excellent in 57.1% （n = 32）, good in 32.1% （n = 18）, fair in 8.9% （n = 5 ）, poor in 1.8% （ n = 1 ）. The good to excellent rate was 89.3%. The average DASH score was 17.7 points. Thirty-eight patients had no functional restriction, 15 had slight restriction,2 had medium restriction,and 1 had severes functional restriction. [Conclusion] The individual therapeutic regimen should be made for intra-articular fractures of the distal radius according to the types of fractures. The wrist function might obtain the best recovery by choosing the optimal fixation combined with reasonable rehabilitation exercises after operation.