蝶形锁定钢板在复杂桡骨远端骨折中的应用

APPLICATION OF BUTTERFLY SHAPED LOCKING COMPRESSION PLATE IN COMPLEX DISTAL RADIUS FRACTURES

目的探讨蝶形锁定钢板内固定治疗复杂桡骨远端骨折的疗效。方法2011年6月-2013年1月，采用蝶形锁定钢板内固定治疗伴桡骨茎突和／或乙状切迹骨折的桡骨远端骨折20例。其中男11例，女9例；年龄25～75岁，平均54岁。致伤原因：跌伤10例，交通事故伤7例，高处坠落伤3例。均为闭合性骨折，根据AO骨折分型：C1型8例，C2型8例，C3型4例。伴桡骨茎突骨折9例，乙状切迹骨折4例，桡骨茎突和乙状切迹均骨折7例。受伤至手术时间3～15d，平均5．2d。结果术后切口均I期愈合，无感染及皮肤坏死等早期并发症发生。20例均获随访，随访时间10～22个月，平均14个月。随访期间患者无腕管综合征表现。x线片复查示骨折均愈合，愈合时间6～11周，平均9．3周；无骨折移位，关节面轮廓良好、无塌陷，桡骨未见明显短缩等。末次随访时，掌倾角7～15°，平均10．2°；尺偏角17～24°，平均21．8°。腕关节活动范围：背伸35～68°，平均45．3°；屈曲40～78°，平均53．5°；桡偏12～27°，平均19．8°；尺偏18～31°，平均26．6°；旋前45～90°，平均70．2°；旋后25～88°，平均68．4°。根据Dienst等评分标准评价腕关节功能，获优8例，良10例，一般2例，优良率为90％。结论对于复杂桡骨远端骨折，蝶形锁定钢板可较好维持骨折复位，特别对于桡骨茎突和乙状切迹骨折能起牢固固定作用，允许术后早期功能锻炼，可获良好的腕关节和下尺桡关节功能。

Objective To investigate the effectiveness of butterfly shaped locking compression plate for the treatment of complex distal radius fractures. Methods Between June 2011 and January 2013, 20 cases of complex distal radius fractures were treated with butterfly shaped locking compression plate fixation. There were 11 males and 9 females with an average age of 54 years （range, 25-75 years）. Injury was caused by falling in 10 cases, by traffic accident in 7 cases, and by falling from height in 3 cases. All of fractures were closed. According to AO classification system, there were 8 cases of type C1, 8 cases of type C2, and 4 cases of type C3. Of them, 9 cases had radial styloid process fracture, 4 cases had sigmoid notch fracture, and 7 cases had both radial styloid process fracture and sigmoid notch fracture. The mean interval between injury and operation was 5.2 days （range, 3-15 days）. Results All incisions healed by first intention; no complications of infection and necrosis occurred. All cases were followed up 14 months on average （range, 10-22 months）. All factures healed after 9.3 weeks on average （range, 6-11 weeks）. No complications such as displacement of fracture, joint surface subsidence, shortening of the radius, and carpal tunnel syndrome were found during follow-up. At last follow-up, the mean palmar tilt angle was 10.2° （range, 7-15°）, and the mean ulnar deviation angle was 21.8° （range, 17-24°）. The mean range of motion of the wrist was 45.3° （range, 35-68°） in dorsal extension, 53.5° （range, 40-78°） in palmar flexion, 19.8° （range, 12-27°） in radial inclination, 26.6° （range, 18-31°） in ulnar inclination, 70.2° （range, 45- 90°） in pronation, and 68.4° （range, 25-88°） in supination. According to the Dienst scoring system, the results were excellent in 8 cases, good in 10 cases, and fair in 2 cases, and the excellent and good rate was 90%. Conclusion Treatment of complex distal radius fractures with butterfly shaped locking compression plate can reconstruct normal anatomic structures, especially for radial styloid process and sigmoid notch fractures, and it can get good functional recovery of the wrist and the distal radioulnar joint.