桡骨远端Die-punch骨折的分型分类和临床特点

The classification and clinical characteristics of Die-punch fracture of distal radius

[目的]探讨桡骨远端Die-punch骨折的分型分类和临床特点。[方法]纳入标准：桡骨远端仅尺侧半关节面受冲撞挤压所造成的骨折。排除标准：桡骨远端尺侧半和桡侧半关节面均有骨折；桡骨远端尺侧半关节面骨折伴桡骨远端干骺端粉碎骨折；开放性桡骨远端尺侧半关节面骨折。回顾性分析2004年1月～2011年12月期间符合标准共纳入的30例Die．punch骨折患者，男18例，女12例；年龄20～51岁，平均35．1岁。骨折均经X线片和CT确诊，按其病理改变分五型，包括背侧型、掌侧型、劈裂型、塌陷型和劈裂加塌陷型。随访10～28个月，平均随访13个月。[结果]背侧型8例，掌侧型3例，劈裂型5例，塌陷型9例，劈裂加塌陷型5例。有移位27例，移位不明显3例。移位不明显者3例中，2例X线片放射学检查报告阴性。随访骨折均愈合，愈合时间5-8周，平均6．0周，3例骨折复位不良者有创伤性腕关节炎表现（发生率10％）。[结论]桡骨远端Die-punch骨折是一种特殊的关节内骨折，包括背侧型、掌侧型、劈裂型、塌陷型、劈裂加塌陷型，在AO分型上归属于B4型较为合理。好发生于青中年，未见发生于儿童报道，也极少见老年性骨质疏松患者。x线平片检查对骨折移位不明显者容易漏诊，需要CT检查确诊。骨折愈合率高，但骨折有移位或复位不满意者，有创伤性腕关节炎可能，宜早期手术治疗。

Objective ] To explore the classification and clinical characteristics of Die-punch fracture of distal radius. [ Method ] Inclusion criteria：fracture of only the ulnar surface of distal radius caused by collision. Exclusion criteria：fracture of the ulnar surface of distal radius associated with fracture of the radius surface of distal radius ; fracture of the ulnar surface of dis- tal radius associated with burst fracture of the metaphysis of distal radius ; open fracture of the ulnar surface of distal radius. Thir- ty cases of Die-punch fracture of distal radius were incluced and retrospectively studied between January 2004 and December 2011 ,with 18 males and 11 females,aged 20 to 51 years old with an average of 35.1 years old. The fractures were confirmed by X-ray and CT scan. They were divided into 5 types according to the location and characteristics of fracture：the volar, the dorsal, the split,the collapse and the split associated with collapse. All patients were followed up for 9 to 28 months with an average of 13 months. [Result]We found the dorsal in 8 cases,the volar in 3 cases,the split in 5 cases,the collapse in 9 cases and the split associated with collapse in 5 cases. Fractures displaced in 27 cases and fractures had not obvious displaced in 3 cases. The reports of X-ray examination for 2 of the 3 cases of fractures not obvious displaced were negative. The healing time of fracture was 5 - 8 weeks with an average of 6.0 weeks in followed-up. Three cases with dissatisfied reduction of fracture had traumatic arthritis（ incidence was 10% ）. [ Conclusion] Die-punch fracture of distal radius is a special type of intra-articular fracture, which includes the volar, the dorsal, the split, the collapse and the split associated with collapse types. It is more reasonable to be attributed to B4 type in the AO classification. It mainly occurred in the young and middle-aged, there was no report occurred in children, as well as seldomly occurred in senile with osteoporosis. X-ray examination for not obvious displaced fracture could be easily missed,in which CT scan is necessary to conform. The healing rate of fracture is high, but fractures of displaced and with dissatisfied reduction may cause traumatic arthritis of the wrist, which should be taken early operation.