桡骨远端骨折术后短缩的原因及对策

The causes and strategies for the postoperative shortening in distal radius fractures

目的:分析桡骨远端骨折术后出现短缩的原因,提出预防措施,提高桡骨远端骨折手术的复位效果及远期疗效。方法:2005年6月至2009年1月,治疗桡骨远端骨折并获随访46例患者,男17例,女29例;年龄27～90岁,平均48岁。获得解剖复位或基本达解剖复位,对术后出现桡骨短缩的现象进行分析。结果:46例获得随访,时间6个月～2年,平均14个月,有12例发生桡骨短缩。总结桡骨远端骨折术后短缩的原因:①年龄大于60岁;②重度骨质疏松;③移位大、粉碎性骨折;④固定方式选择不恰当;⑤植骨不充分;⑥过早负荷。结论:术前正确判断骨折类型及骨的质量、充分植骨、解剖复位后牢固固定及早期非负荷功能锻炼是减少桡骨骨折术后短缩、提高桡骨远端骨折疗效的关键。在桡骨远端骨折手术及术后康复锻炼中,如能充分考虑上述6种造成桡骨短缩的原因并加以克服,将可能避免或延缓创伤性关节炎的发生。

Objective：To analyze the cause of the postoperative shortening in distal radius fractures and to find treatment strategies to enhance the reduction effect of distal radius fracture and long term efficacy. Methods：From June 2005 to January 2009,46 patients with distal radius fractures were treated by surgical operation including 17 males and 29 females,ranging from 27 to 90 years old with an average age of 48 years. All fractures were reduced satisfactory with smooth articular surface.The post operative radial shortening was analyzed. Results：All patients were followed up for 6 to 24 months with an average of 14 months. Among them,12 patients had radial shortening. The causes of postoperative radial shortening includes： ①patient solder than 60 years;②severe osteoporosis;③preoperative displacement and comminuted fractures;④inappropriate fixation methods;⑤inadequate bone graft;⑥premature load. Conclusion：The key points to enhance the treatment out comes includeprecise judgement of the fracture type and bone quality,sufficient bone graft,firmly fixed after anatomical reduction and an appropriate plan for early loadless functional exercise. Traumatic arthritis may be avoided or delayed if the abovementioned sixcauses can be taken into consideration or preventive measures can be taken.