锁定钢板治疗骨质疏松C型桡骨远端粉碎性骨折

Treatment of C Type Distal Radius Fractures with Osteoporosis by Open Reduction and DVR Plate Fixation

目的研究桡骨远端解剖锁定钢板治疗桡骨远端粉碎性骨折的效果。方法 60例闭合桡骨远端骨折,平均年龄59岁。均由双能X线检查诊断为骨质疏松患者。按照AO骨折分型,C1型10例,C2型33例,C3型17例。手术均采用掌侧入路,行切开复位桡骨远端解剖锁定钢板固定术,术后进行影像学评价及DASH(disability of the armshoulder and hand)评分、PRWE(patient-reled wirst evaluation)评分、Greenand O'Brien评分。结果术后随访8～20个月,平均10个月。其中17例失访,共43例进行统计。平均术后第5天患者进行主动腕关节活动锻炼。6个月后腕关节活动度平均为掌屈62°,背伸40°,尺偏28°,桡偏20°,旋前70°,旋后67°。最近一次随访X线片与术前比较,桡骨茎突平均增加5 mm,平均掌倾角自术前—18°(—43°～12°)增加至12°(—3°～20°)。平均尺偏角从11°(—6°～20°)增加至20°(10°～25°)。距关节面最远骨折块与关节线位移从10 mm(1～16 mm)减少至0.3 mmnm(0～3 mm)。术侧握力为健侧的83%(62%～100%)。DASH评分平均11.1(0～17.2),PRWE评分平均9.6(0～12.5),Green and O'Brien评分优27例,良8例,一般5例,差3例。结论对于AO分型为C型桡骨远端骨折,桡骨远端解剖锁定钢板可以稳定的维持骨折复位,允许术后进行早期功能锻炼,可获得较满意的临床治疗效果。

Objective To evaluate the treatment results of open reduction and DVR plate fixation for C type distal radius fractures（DRFs）. Methods Sixty patients of distal radius fractures with a mean age of 59 years were involved in this series. All the patients were diagnosis as osteoporosis. The fractures were classified as AO type ..type C1 in 10 cases;type C2 in 33 cases,and type C3 in 17 eases. All the fractures were treated with open reduction and locking compression plate （DVR） fixation in a volar approach. Objective and subjective functional results （active range of mo-tion ; grip strenght ; disabilitiesof the a4rm, shoulder and hand （DASH） score ; patient rated wrist evaluation （PRWE） score;and Green and O＇Brien score） and radiopraphic assessment were assessed. Results Followup ranged from 8 to 20 months,the average being 10 months. The mean range of motion of the wrist reached 62°of flexion, 40°of exten-sion, 28° of ulnar deviation, 20° of radial deviation, 70°of pronation,and 67°of supination. X rays taken at last followup showed an increase of radial styloid length from preoperative 5 ram. The volar tilt increased from -18°（-43°- 12°） to 12°（-3°-20°）. The ulnar inclination increased fromll°（-6°-20°） to 20°（10°-25°）. The intra ar ticular step off decreased from 10 mm（l-16 ram） to 0.3 mm （0~3 mm）. Grip strength was 83% （62%-100%） of that of the unin-jured side. DASH score was average 11.1 （0-17.2）, PRWE score was average 9.6 （0-12.5） ,According to the criteri-a of Green and OPBrien,the results were excellent in 27 cases,good in 8 cases ,fair in 5 cases,poor in 3cases. Conclu-sion Locking plate can maintain reduction of the displaced in tra-articular fractures of the distal radius. Early move- ment was allowed ,and good wrist function can be achieved.