掌侧锁定加压钢板治疗桡骨远端不稳定骨折的回顾性研究

Retrospective Study of Distal Radius Fractures Treated with a Volar Locking Plate

目的回顾性研究掌侧锁定加压钢板(LCP)固定治疗不稳定、背侧移位桡骨远端骨折的临床效果。方法利用掌侧LCP治疗不稳定、背侧移位桡骨远端骨折55例,允许患者手术后活动腕关节。分别在手术后的第5周、3个月、6个月、1年后进行随访。术前术后标准腕关节正侧位X线片测量掌倾角、尺倾角、径向长度、尺骨差异、关节面落差。采用改良Gartland和Werley评分标准评定腕关节功能恢复情况,进行统计学分析,并采用上肢功能评定表问卷调查。结果经摄X线片复查显示,本组患者术后1年桡骨径向差异平均9mm,平均掌倾角22°,尺倾角平均1°,关节面平均落差0mm。通过1年的随访,根据系统的Gartland和Werley评分为100%,腕关节活动度良好,上肢功能评定表评分平均为6分,显示了患者高度的满意度。无感染病例以及复杂区域疼痛综合征、肌腱断裂、肌腱炎、神经损伤或内固定失败等。结论对不稳定背侧移位桡骨远端骨折掌侧LCP是一种安全有效的治疗方法,可有效防止复位丢失、减少结构性植骨、避免肌腱激惹等并发症。

Objective To retrospective study volar plate （locking compression plate, LCP） fixation for the treatment of unstable distal radius fracture with dorsal displacement of fractures and its effects.Methods Internal fixation and early mobilization of dorsally displaced, unstable fractures of the distal radius using a volar locking plate system without bone grafting was investigated in a prospective series of 55 fractures in 49 consecutive patients.All patients were allowed to move the wrist joint immediately after surgery.Physical examination at 5 weeks, 3 months, 6 months, and 1 year after the operation were performed.Radiographic parameters on preoperative,postoperative, and 1- year postoperative radiographs were compared.At 1-year review, the final clinical functions were evaluated with the Garfland and Werley functional scoring system, and the disabilities of the ann, shoulder, and hand questionnaire.Results The average radiographic results at 1 year were 9°of volar tilt,22°of radial inclination, 1 mm of ulnar variance, and 0 nun of articular incongruity.At 1-year review, an excellent or good result was found according to the system of gartland and werley with scores of 100% ,respectively.The disabilities of the arm, shoulder, and hand score averaged 6,indicating a high degree of patient satisfaction.There were no cases of infection, complex regional pain syndrome, tendon rupture, tendon irritation,nerve injury, or implant failure.Conclusion For instability, dorsal displacement of distal radius fractures, volar LCP is safe and effective in preventing loss of reduction,reducing the structural bone graft and avoiding complications such as tendon bowel.