跨关节外固定架联合克氏针治疗开放性桡骨远端骨折

Outcomes of open distal radius fractures managed with bridging external fixator and Kirschner-wire fixation

目的：观察跨关节外固定架联合克氏针治疗开放性桡骨远端骨折的效果。方法回顾2009年10月至2010年10月间在北京积水潭医院住院的跨关节外固定架联合克氏针治疗的开放性桡骨远端骨折9例。其中女6例，男3例。平均年龄60.0岁（17～79岁）。受伤机制：摔伤5例，高处坠落伤1例，交通伤2例。手术距受伤时间平均7.2（4～9）h。按照Gustilo和Anderson开放骨折分型：Ⅰ型2例，Ⅱ型3例，ⅢA型4例。2例患者存在其他部位的合并损伤，4例合并局部肌腱或神经血管损伤，1例合并前臂筋膜间室综合征。随访患者临床功能和影像学结果。结果骨折按照AO/OTA分型：A2骨折1例，A3骨折4例，C3骨折4例。7例合并尺骨远端骨折，4例存在下尺桡关节脱位。所有患者均采用跨腕关节外固定架结合克氏针固定，4例患者同时进行了下尺桡关节的贯穿克氏针固定。9例患者均获得随访，随访时间平均2.8年（1.9～3.5年）。依据改良的Green和O′Brien评分，功能优2例，良4例，可1例，差2例。所有骨折均愈合。并发症包括：1例患者因固定失效进行了再次手术，2例发生外架针道感染，未出现开放伤口部位和骨折端的感染，5例发生克氏针松动。结论跨关节外固定架联合克氏针治疗开放性桡骨远端骨折的效果并不十分令人满意。这一固定方法可能并不是所有开放性桡骨远端骨折的最佳选择。

Objective To explore the clinical outcomes of open distal radius fractures managed with bridging external fixator and Kirschner-wire.Methods Retrospective reviews were conducted for 9 patients with open distal radius fractures managed with bridging external fixator and Kirschner -wire between October 2009 and October 2010.There were 6 females and 3 males with a mean age at injury of 60.0 （ 17 -79 ） years.The mechanisms were fall from standing height （n=5）,fall from height ＆gt;2 meters （n=1） and traffic accident （ n=2）.The average time from injury to operation was 7.2 （4-9） hours.According to the Gustilo and Anderson classification ,the grades were Ⅰ （ n=2 ） ,Ⅱ （ n=3 ） and ⅢA （ n=4 ）.Two patients had additional injuries in other areas.Four patients had associated tendon ,nerve or artery injury around wrist.One patient had ipsilateral forearm compartment syndrome.The clinical and radiological outcomes were followed.Results According to the AO/OTA classification,there were A2 （n=1）,A3 （n=4） and C3 （n=4）.Seven patients had distal ulnar fractures and 4 suffered a dislocation of DRUJ （distal radial ulnar joint）.All distal radius fractures were fixed with bridging external fixator and Kirschner-wire.Percutaneous pin fixation of DRUJ was performed in 4 patients because of instability of radial or ulnar fractures.Nine patients were followed up for an average period of 2.8 （1.9-3.5） years.According to the modified Green and O′Brien score,the clinical outcome at the time of final follow-up was graded as excellent （n=2）,good （n=4）,fair （n=1） and poor （n=2）.All fractures were healed.The complications included fixation failure and revision （n=1）,fixator pin site infection （n=2） and Kirschner-wire loosening （n=5）.Conclusions The outcomes of open distal radius fractures managed with bridging external fixator and Kirschner -wire are unsatisfactory.And this fixation method may not be optimal for all open distal radius fractures.