微创掌侧锁定钢板治疗桡骨远端骨折

Minimally invasive palmar locking plate for treatment of distal radius fractures

目的探讨微创掌侧插入锁定钢板治疗桡骨远端骨折的临床效果、可行性、注意点和并发症。方法选择2009年8—2010年8月收治的22例桡骨远端骨折患者，应用微创掌侧锁定钢板治疗。按AO分型：A2型5例，A3型3例，B1型4例，B3型7例，c1型2例，C2型1例。采用掌侧2条垂直或平行的切口，切口均长2cm，其中远端横切口即沿腕近纹切开，两端纵切口紧贴桡侧腕屈肌桡侧切开，经旋前方肌深部插入锁定钢板固定。结果术后随访10一18个月，平均12个月。按Dienst功能评估标准：优13例，良6例，可3例，差0例，优良率为86％。手术并发症：腕近纹处横切口延迟愈合1例；大鱼际部麻木1例，术后3个月症状消失；残留腕关节尺侧痛2例；腕关节功能受限2例。结论微创掌侧锁定钢板治疗桡骨远端骨折安全、创伤小、固定可靠，利于早期功能锻炼，切口外形美观，符合微创理念，值得推广。

Objective To investigate the clinical effects, feasibility, points for attention and complications of treating distal radial fractures through minimally invasive palmar locking plate. Methods A total of 22 patients with distal radial fractures managed by minimally invasive palmar locking plate from August 2009 to August 2010 were enrolled in the study. According to AO classification, there were five patients with type A2 fractures, three with type A3, four with type B1, seven with type B3, two with type C1 and one with type C2. Two vertical or parallel palmar incisions of 2 cm long were performed. The distal transverse incision was along the proximal wrist crease, while the distal and proximal vertical incisions were close to the radial side of flexor carpi radialis. Then, palmar locking plate was inserted through deep pronator quadratus. Results Follow-up period was 10-18 months （mean, 12 months）. According to Dienst function evaluation criteria, the results were excellent in 13 patients, good in six, fair in three and poor in zero, with excellence rate of 86%. Complications were as follows ： one patient had delayed healing of proximal wrist crease incision; one patient had numbness of thenar eminence and the symptom was disappeared three months postoperatively; two patients remained pain on ulnar side of the wrist joint; two patients had limited function of the wrist joint. Conclusions Minimally invasive palmar locking plate is safe, mini-invasive and reliable when treating distal radial fractures, which is conducive to early functional exercise. Furthermore, the method achieves satisfactory appearance of the incision which meets the minimal invasion and thus deserves clinical practice.