桡骨远端C3．1型骨折的手术方式探讨

Surgery for type C3.1 fractures of distal radius

目的 探讨桡骨远端C3.1型骨折的手术入路及固定方法. 方法 回顾性分析2007年1月至2009年8月收治且获得随访的40例桡骨远端C3.1型骨折患者资料,男17例,女23例；年龄47～65岁（平均58.2岁）.根据手术入路不同分为掌侧入路组（25例,单纯掌侧入路锁定钢板内固定11例,掌侧入路加背侧辅助切口克氏针、螺钉内固定14例）和背侧入路组（15例,均采用背侧入路锁定钢板内固定）,比较两组患者的骨折愈合时间、术后12个月掌倾角、尺偏角及桡骨茎突高度,以及术后6、24个月腕关节活动度.结果 40例患者术后获平均2.3年（2.0～2.5年）随访.两组患者骨折愈合时间[（8.1±2.2）、（8.3±1.7）周]、术后12个月掌倾角（9.3°±2.1°、9.5°±1.7°）、尺偏角（20.0°±2.7°、18.7°±2.5°）、桡骨茎突高度[（8.6±2.9）、（7.9±2.3） mm]比较差异均无统计学意义（P＞0.05）.术后6个月背侧入路组腕关节掌屈（58.3°±1.7°）、背伸（55.0°±1.6°）活动度较掌侧入路组（67.5°±2.0°、59.2°±1.9°）差,差异有统计学意义（P＜0.05）,两组患者旋前、旋后活动度差异无统计学意义（P＞0 05）；术后24个月两组患者腕关节活动度差异均无统计学意义（P＞0.05）.背侧入路组1例术后1个月出现骨折复位丢失,3例于术后1年取出内固定物. 结论 与背侧入路锁定钢板内固定相比,掌侧入路锁定钢板内固定（或加背侧辅助切口）治疗桡骨远端C3.1型骨折可以更好地恢复和维持关节面骨折块的复位,术后并发症少,更有利于早期进行功能锻炼.

Objective To discuss the surgical approaches and fixation methods for displaced type C3.1 fractures of distal radius. Methods Between January 2007 and August 2009,40 patients with type C3.1 fracture of distal radius were treated in our department.They were 17 men and 23 women,aged from 47 to 65 years （average,58.2 years）.They were divided into 2 groups according to the surgical approach adopted.In group A,the simple volar approach plus locking plating was adopted in 11 cases and the volar approach plus auxiliary incision through the dorsal approach plus internal fixation with Kirschner wire and screws was adopted in 14 cases.In group B,the dorsal approach plus dorsal approach locking plating was adopted in 15 patients.The 2 groups were compared in terms of fracture healing time,palmar tilt,radial inclination and radial styloid height at 12 months postoperation and range of motion of the wrist at 6 and 24 months postoperation. Results The average follow-up period was 2.3 years （range,2.0 to 2.5 years）.Bone union was achieved in all patients.There were no significant differences between the 2 groups in fracture healingtome （8.1±2.2 vs.8.3±1.7）,palmar tilt （9.3°±2.1° vs.9.5°±1.7°）,radial inclination （20.0° ± 2.7° vs.18.7° ± 2.5°） and radial styloid height （8.6 ± 2.9 mm vs.7.9 ± 2.3 mm） at 12 monthspostoperation （ P 〉 0.05 ）.The palmar flexion （58.3° ± 1.7°） and dorsal extension （55.0° ± 1.6°） at 6 months postoperation in group B were significantly smaller than those （67.5° ± 2.0° and 59.2° ± 1.9° ） in group A （ P 〈 0.05）,but there was no significant difference between the 2 groups in pronation or supination （ P 〉 0.05）.There was no significant difference between the 2 groups in the range of motion of the wrist at 24 months postoperation （ P 〉 0.05）.One patient in group B was found to have lost his fracture reduction and 3 patients were admitted to hospital for implant removal one year after operation. Conclusion In the treatment of type C3.1 fractures of distal radius,the volar approach plus locking plating （or with an additional auxiliary incision through the dorsal approach） can provide better fracture reduction and stabler fixation to reduce surgical complications than the dorsal approach plus locking plating.