掌侧锁定钢板联合背侧入路植骨治疗桡骨远端背侧不稳定性骨折

Combined with implantment of the artificial bone into bone defects through dorsal approach Volar locking compression plate fixation for dorsaly displaced fractures of distal radius

[目的]探讨掌侧锁定钢板联合背侧入路植骨在治疗桡骨远端背侧不稳定性骨折的应用及临床疗效。[方法]总结2005年8月~2010年1月经掌侧入路锁定钢板联合背侧入路植骨治疗桡骨远端背侧不稳定性骨折27例。男8例,女19例,年龄55.6岁（50~65岁）,按AO分类：A3型12例,C2型10例,C3型5例,均为闭合性骨折。所有病例均采取掌侧入路,局限性显露背侧骨折端并行骨诱导活性材料（金世植骨灵）镶嵌支撑植骨。术后均予以石膏托外固定2周。[结果]27例全部获得随访,随访时间平均17.5个月（12～24个月）。X线片显示骨折全部I期愈合,平均愈合时间为8周。术后1年X线片测量：桡骨茎突短缩均≤2 mm;掌倾角10.5°（5°～17°）;尺偏角19.5°（15°～26°）;关节面塌陷、移位矫正均≤2 mm;1例显示关节间隙变窄。术后功能康复时间8~30周,平均20.5周。术后患侧腕关节运动范围为：掌屈60°（30°～70°）;背伸55°（30°～65°）;桡偏：17°（10°～20°）;尺偏25.5°（20°～30°）;前臂旋前65.5°（60°～70°）;旋后75.5°（60°～80°）。握力测量平均为健侧的65%（45%～95%）。伴有疼痛的4例其中偶有轻度疼痛的3例,中度疼痛的1例。根据Gartland-Werley腕关节评分标准：优17例,良6例,可3例,差1例,优良率为85.2%。所有病例均无感染、骨不连、钢板松动、腕管综合征、正中神经炎、肌腱损伤并发。[结论]掌侧锁定钢板联合背侧入路植骨治疗桡骨远端背侧不稳定性骨折,可保证植骨质量,促进骨折愈合并防止复位丢失,配合适当的术后功能锻炼,可取得良好的疗效。

[Objective]To investigate the usage and the clinical outcome of volar locking compression plate fixation for dorsaly displaced fractures of distal radius combined with implantment of the artificial bone into bone defects through dorsal approach.[Method]From Aug.2005 to Jan.2010,27 cases with dorsally unstable distal radius fractures were treated with open reduction and internal fixation with T-LCP.This study involved 8 males and 19 females with an average age of 55.6 years（ranged from 50 to 65 years old）.According to AO classification：12 cases of type A3,10 cases of type C2,5 cases of type C3,all of them were closed fractures of distal radius.The fractures of 27 cases were fixed with T-LCP by volar approach and combined with implantment of the Osteoinduction Active Material into bone defects through dorsal minimal incusion.Twenty-seven cases were all treated postoperatively with cast immobilization for 2 weeks.[Result] Twenty-seven cases were followed up for 12 to 24 months and the average time was 17.5 months.The X-ray pictures showed that unions had been achieved in all patients and a mean healing time was 8 weeks.Final volar tilt was averaged 10.5°,ulnar tilt 19.5°and radial shortening were ≤2mm.Step-off or gap of the articular surface ≤2mm.The average final volar flexion was 60°,dorsal flexion 55°,ulnar deviation 25.5°,radial deviation 17°,pronation 65.5°and supination 75.5°.Grip strength was 65% of the contralateral side.The functional recovery was achieved from 8 to 30 weeks with an average time of 20.5 weeks after operation.According to Gartland and Werley wrist scoring system,there were 17 excellent,6 good,3 fair and 1 poor results and the satisfactory rate was 85.2%.No complication was found as infection,nonunion,loosing of nails,CTS,medium neuritis and tendon injury.[Conclusion]The volar fixation of LCP for dorsally displaced fractures of distal radius combined with implantment of the artificial bone into bone defects through dorsal approach,as can improve the quality of bone graft,increase bone healing and prevent reduction loss,provides solid fixation to the fractures.Supplemented with appropriate post-operative training satisfactory results can be achieved.