桡骨远端掌侧解剖锁定接骨板治疗桡骨远端骨质疏松性骨折的疗效观察

Clinical observations on treating osteoporotic distal radial fractures with DVR anatomic locking plates

背景:近年来桡骨远端掌侧(DVR)解剖锁定接骨板广泛应用于桡骨远端骨折的治疗,尤其是桡骨远端骨质疏松性骨折。目的:评价DVR解剖锁定接骨板治疗桡骨远端骨质疏松性骨折的临床疗效。方法:2009年5月至2011年12月共收治桡骨远端骨折87例,确诊为桡骨远端骨质疏松性骨折的29例行DVR解剖锁定接骨板掌侧入路固定。男11例,女18例;年龄56-78岁,平均63岁;骨折按AO分型:A2型3例,A3型6例,B1型1例,B3型2例,C1型6例,C2型7例,C3型4例;受伤距手术时间为1～12d,平均5d。结果:术后伤口均一期愈合,无一例出现术后感染。29例中21例获得随访,随访时间为12～20个月,平均14个月。影像学检查示均达到骨性愈合,愈合时间为12～18周,平均15周。末次随访时患者腕关节活动度:背伸41°～68°,平均52°;掌屈45°～78°,平均57°;旋前63°～86°,平均77°;旋后57°～80°,平均74°。末次随访采用Sarmiento改良Gartland&Werley评分方法:优13例,良6例,可2例,差0例;腕关节VAS评分:腕关节完全无痛18例,轻度疼痛2例(评分为2分和2.5分),中度疼痛1例(评分为4分)。无一例出现肌腱激惹;正中神经卡压1例,骨折愈合后6个月取出内固定并行松解术后症状完全消失;骨折背侧骨片移位1例,未对腕关节功能产生影响遂未予以处理。在背伸、掌屈、旋前、旋后4个方向的活动度比较,A型与B型骨折比较无统计学差异;A型与C型,B型与C型比较均存在统计学差异。结论:DVR解剖锁定接骨板板治疗桡骨远端骨质疏松性骨折可以获得良好的功能转归,C型骨折较A、B型骨折对腕关节活动影响更大。

Background：In recent years,DVR anatomic locking plates has been widely used in treating distal radius fractures,especially the osteoporotic distal radial fractures.Objective：To evaluate the clinical effects of DVR anatomic locking plates in treating the osteoporotic distal radial fractures.Methods：From May 2009 to December2011,29 out of 87 patients with distal radius fractures were diagnosed with osteoporosis and received the DVR treatment from volar approach.11 were males and 18 were females.The average age was 63 years old（45-78 years old）.According to AO classification system,there were 3 fractures of A2 type;6 of A3 type;1 fracture of B1 type,2 of B3 type;6 of C1 type,7 of C2 type and 4 of C3 type.The surgery was performed with an average of 5 days（1-12 days） after the injury.Results：All cases were healed by first intention,and no postoperative infection occurred.21 out of 29 patients were followed up for an average period of 14 months（12～20 months）.The image examination results showed that all patients achieved bone union after an average period of 15 weeks（12～18 weeks）.At the last follow-up,the average ROM（range of motion） of the wrist joints were 52°（41°-68°）,57°（45°-78°）,77°（63°-86°）,74°（57°-80°） for dorsiflexion,palmer flexion,pronation and supination respectively.According to Gartland Werley Scores modified by Sarmiento,there were 13 excellent cases,6 good,2 fair and 0 poor;Evaluated by VAS score system,18 cases were painless,2 were of mild pain（scored 2 and 2.5 respectively） and 1 was of moderate pain（scored 4） at the last follow-up.There was no tendon irritation or rupture,but one case of median nerve irritation and another case of bone fracture displaced on dorsal side.The syndrome of median nerve irritation disappeared after removing the interior fixation and a decompression surgery performed six months after the fracture was healed.For the syndrome of bone fracture displaced on dorsal side,since it has no impact on wrist function,no actions were taken to deal with it.As for the comparison of ROM of dorsiflexion,palmer flexion,pronation and supination,there were statistical differences between A type and C type,B type and C type,but no statistical difference between A type and B type.Conclusions：Treating osteoporotic distal radius fractures with DVR anatomic locking plates can achieve satisfactory functional recovery.C type fracture has more impact on wrist function compared to A type and B type fractures.