外固定架结合微创植骨治疗老年骨质疏松性桡骨远端骨折

Treatment of Osteoporotic Distal Radius Fractures in the Elderly by External Fixator Combined with Minimally Invasive Grafting Bone

目的探讨外固定架结合微创植骨治疗老年骨质疏松性桡骨远端骨折的临床疗效。方法自2004年12月至2008年2月采用外固定架结合微创植入人工骨治疗老年骨质疏松性桡骨远端骨折40例。男19例,女21例;年龄65~88岁,平均74.3岁。按AO/ASIF分型,A3型10例,C2型12例,C3型18例。开放性骨折4例,但皮肤及软组织损伤较轻,污染轻。手术方法中单纯手法牵引复位加外固定架,经皮撬拨利用微创技术局部注射人工骨。受伤至手术时间为10.5 h^5 d,平均3.6 d。结果平均手术时间是32 min。术中平均出血量是20 mL。平均手术切口长度是2 cm。术后随访8~16个月,平均13个月。按照解剖学上的恢复结果,解剖复位12例,功能复位26例,接近功能复位2例。术前尺偏角为-15°~15°(平均10.5°)及掌倾角-30°~0°(平均-10°),术后尺偏角20°~35°(平均25°)及掌倾角0°~20°(平均11.5°)。关节功能疗效按Dienst功能评估标准进行评定,优12例,良25例,可3例。无针道感染,无针孔骨折,无医源性神经、血管损伤,无伤口感染及骨髓炎等并发症。结论外固定架结合微创植骨是治疗老年骨质疏松性桡骨远端骨折的一种损伤小的手术方法,其操作简单、固定可靠、疗效满意、并发症少。为老年骨质疏松性桡骨远端骨折的治疗提供一种能明显促进骨折愈合、减少术后感染的新方法。

Objective To discuss the clinical effects of external fixator combined with minimally invasive grafting bone in the treatment of Osteoporotic distal radius fractures in the elderly.Methods 40 patients with Osteoporotic distal radius fractures in the elderly were treated by external fixator combined with minimally invasive grafting bone from December 2004 to February 2008.There were 19 males and 21 females with an average age of 74.3 years（range,65～88 years）.According to AO/ASIF classification,10 fractures were A3 type,12 C2,and 18 C3.Reduction was achieved and maintained in the all cases by longitudinal traction and external fixation,injecting artificial bone of using a minimally invasive technique with percutaneous K-wire.3 by external fixatator combined with ulnar limited internal fixation.The average time is 3.6 days（range,10.5 hours-5 days）from hurt to operation.Results The mean operation time was 32 minutes（range,25 to 40 minutes）.The mean intraoperative blood loss was 20 mL（range,12 to 35 mL）.The mean length of incision was 1 cm（range,0.7 to 1.3 cm）.All the patients were followed up from 8 months to 16 months（13 months on average）.According to the anatomical alignment,12 were excellent,26 good,and 2 fair.It was necessary to restore the anatomy of distal radius both on sagittal and coronal planes in order to obtain good functions.Preoperatively,the radial inclination angle was-15° to 15°（10.5° on average）,and the palmar tilt angle was-30° to 0°（-10° on average）.After operation,the two angels were reduced to 20° to 35°（25° on average）,and 0° to 20°（11.5° on average）respectively.The joint function was assessed by Dienst criteria,the results suggested that 12 were graded as excellent,25 good,and 23 fair.No severe complications were found.Conclusion The treatment of Osteoporotic distal radius fractures in the elderly using external fixator combined with minimally invasive grafting bone of less operative trauma,reliable fixation,satisfactory effect,and lower complications.It offers a new method which can obviously improve the union of the fractures and decrease the infection rate postoperatively for the treatment of the Osteoporotic distal radius fractures in the elderly.