三柱理论在治疗桡骨远端复杂骨折中的指导作用

Clinical Result of Complicated Unstable Distal Radial Fractures by Using ORIF Combined with "Three Column Theory"

目的研究和验证桡骨远端复杂骨折在三柱理论指导下的临床疗效。方法从2008年8月～2010年1月以三柱理论为基础,采用掌侧或掌背侧联合切口治疗桡骨远端骨折16例。AO分型:C3型3例,C2型6例,C1型7例。急诊手术1例,余均在4～7 d内手术。术中植骨2例。术中桡侧辅助固定6例,尺骨茎突固定4例,背侧辅助钢板固定2例。结果经随访2～15个月(平均6.3个月),掌倾角、尺偏角、桡骨短缩均获明显改善,腕关节功能按照Gartland-Werley(GW)评价系统对腕部进行功能评估,本组:优13例,良3例。结论以三柱理论为指导治疗桡骨远端复杂骨折,可使骨折得到满意的复位和可靠的内固定,防止复位丢失、避免关节僵硬等。

Objective To explore and prove the clinical result of complicated unstable intra-articular distal radial fracture by using ORIF combined with ＂three column theory＂.Methods From Aug.2008 to Jan.2010,consecutive 16 patients,9 males and 7 females,with the average age of 54 years（range 2371 years）,were treated in our traumatic center.In these cases,left limbs were 10 cases and right limbs 6 cases.According to AO／ASIF classification,there were 7 cases for type C1,6 cases for type C2,and 3 cases for type C3.One patient underwent emergancy operation for openning fracture,the others were operated in 47 days after injury.Among of these patients,2 cases received bone grafting,6 cases auxillary radial fixation,4 cases ulna styloid fixation and 2 cases assisted dorsal fixation.Results All the patients were followed up from 2 to 15 months（average 6.3 months）,compared with preoperation,the paremeter including volar tilt,radial inclination and radial shortening were improved significantly.Thirteen patients achieved excellent results and 3 good according to Gartland-Werley functional assessment system.Conclusion Directed by three column theory,stable ORIF for three column can free the wrist,perform active functional exercise early,avoid reduction loss and joint stiffness,hence obtain an outstanding clinical results.