微型多功能可调式锁针外固定器的研制及在桡骨远端粉碎性骨折中的应用

The Design and Clinical Application of the Multifunctional Micro-adjustable Lock Pin External Fixator for the Serious Comminuted Distal Radiu Fractures

目的探讨自制微型多功能可调式锁针外固定器在治疗桡骨远端粉碎性骨折中的临床疗效和应用价值。方法自2005年7月～2008年12月,采用自制微型多功能可调式锁针外固定器治疗桡骨远端严重粉碎性骨折32例。按AO/ASIF分型:A3型9例,C2型7例,C3型16例,其中开放性5例。治疗采用闭合复位加外固定15例,切开复位加外固定17例,植骨10例。受伤至手术时间为2h～5d,平均3.5d。结果术后随访5～40个月,按照解剖学上的恢复结果,解剖复位8例,功能复位22例,接近功能复位2例。术前尺偏角为-20～10°(平均-10°),掌倾角为-40～0°(平均-12°),术后尺偏角15～25°(平均20°),掌倾角为8～15°(平均12°)。关节功能疗效按Dienst功能评估标准进行评定:优12例,良19例,可1例。无针道及伤口感染,无针孔骨折,无医源性神经血管损伤,无骨不连等并发症。结论自制微型可调式锁针外固定器是治疗桡骨远端严重粉碎性骨折的一种较好方法,其操作简单,固定可靠,价格低廉,疗效满意,并发症少,为桡骨远端严重粉碎性骨折的治疗提供了一种新方法。

Objective To explore the clinical effect and value of the self-made micro-adjustable look pin external fixator in the treatment of serious comminuted distal radius fractures.Methods Thirty-two patients with serious eomminuted distal radiu fractures were treated with self-made micro-adjustable lock pin external fixator from July 2005 to December 2008. There were 19 males and 13 females （mean age,46.5years, range,30-73 years）.Aecording to the AO/ASIF classification, 9 fractures were A3 type,7 C2 and 16 C3, including open fracture 5 cases.15 patients were treated with closed reducation and external fixation,17 by open reducation and external fixation, 10 by bone-grafting.The time between injury and surgery ranged from 2 houres to 5 days,mean 3.5 days.Results All cases were followed up for 5 months to 40 months. According to the anatomical alignment,8 were excellent,22 good, and 2 fair. Preoperatively, the radial inclination angle was -20° to 10°（-10° on average） , and the palmar tilt angle was -40° to 0° （-12° on average）.After operation,the two angels were reduced to 15° to 25° （20° on average）, and 8° to 15° （12°on average） respectively.The joint function was assessed by Dienst criteria. The results suggested that 12 were graded as excellent,19 good, and 1 fair. No severe complications were found.Conclusion The treatment of serious comminuted distal radius fractures using self-made micro-adjustable lock pin external fixator is a good method of easy performance, reliable fixation, satisfactory effect, and less complications.It offers a new way for treating the fractures of distal radius.