掌侧LCP结合Kapandji技术治疗背侧不稳定桡骨远端关节内骨折初步报道

Volar LCP fixation combined with Kapandji technique for dorsal unstable inter-articular distal radial fractures

目的探讨掌侧锁定加压钢板（10ckingcompressionplate，LCP）结合Kapandji技术治疗背侧不稳定桡骨远端关节内骨折的方法及疗效。方法背侧不稳定桡骨远端关节内骨折患者43例，男17例，女26例；年龄42~65岁，平均57岁。按AO／ASIF分型，C1型26例，C2型16例，C3型1例。采用掌侧LCP结合Kapandii技术进行治疗。在Stewart等改良的Sarmiento评分基础上再次进行改良，从掌倾角、尺偏角、桡骨短缩和关节面台阶方面对桡骨远端影像学进行评估；采用Gartland—Werley功能评分对腕关节功能进行评估。结果所有患者均获得随访，随访时间16-47个月，平均27个月。掌倾角由术前-19．3°±11.2°改善至术后8．1°±312°，尺偏角由术前-13．6°±4．1°改善至术后18．0°±8．2°，桡骨短缩由术前（6．2±2．8）mm改善至术后（0．2±0．2）mm，关节面塌陷由术前（5．5±4．3）Inn改善至术后（0．1_0．2）mm。在Stewart等改良的Sarmiento评分基础上再次进行改良的评分，优34例，良9例；Gartland—Werley功能评分，优18例，良22例，可3例。结论掌侧LCP结合Kapandji技术是治疗背侧不稳定桡骨远端关节内骨折的一种有效方法，可有效防止复位丢失、肌腱激惹等并发症，减少结构性植骨及行早期关节活动。

Objective To explore the method and evaluate the effect of volar LCP fixation combined with Kapandji technique for dorsal unstable inter-articular distal radial fractures. Methods Forty-three pa- tients（male 17 and female 26, aged 42 to 65 years with the mean of 57 years） with dorsal unstable inter-articular distal radial fractures were treated with volar LCP combined with Kapandji techniques. There were 26 cases for type C1, 16 cases for type C2 and 1 case for type C3 according to AO/ASIF classification criteria of fractures. To modify again Sarmaiento scale （modified by Stewart first）, and the parameters of imageology of the fractures were estimated, while the wrist function through Gartland-Werley functional assessment system. The effects were evaluated through comparing the volar tilt, radial inclination, articular set-off, radial shortening and wrist function. Results All the patients were followed up from 16 to 47 months （average 27 months） postoperatively, and the volar tilt increased from -19.3°_±11.2° to 8.1°±3.2°, radial inclination in- creased from -13.6°±4.1° to 18.0°±8.2°, the radial shortening decreased from （6.2±2.8） mm to （0.2-±0.2） ram, and articular set-off decreased from （5.5±4.3） mm to （0.1±0.2） mm. Postoperatively, 34 patients achieved excellent and 9 good according to the twice modified Sarmiento scale in the radiologieal manifesta- tion and 18 patients displayed excellent and 22 good with 3 fair according to Gartland-Werley functional as- sessment system. Conclusion Volar LCP fixation combined with Kapandji technique is a safe and effective method for treating the unstable distal radial fractures of type C, which can prevent reduction lost, reduce need for bone grafting, provide for early wrist motion and avoid tendon irritation.