经桡侧入路锁定加压钢板治疗桡骨远端背侧不稳定骨折的疗效

Radial locking compression plate for treatment of distal radius fracture with dorsal instability

目的探讨经桡侧入路锁定加压钢板（LCP）治疗桡骨远端背侧不稳定骨折的临床疗效。方法选择2009年9月--2012年10月经桡侧入路LCP治疗桡骨远端背侧不稳定骨折21例，其中男14例，女7例；年龄38～81岁，平均54．5岁。致伤原因：交通伤12例，跌伤7例，高处坠落伤2例。按AO分型：A3型10例，c1型8例，c2型3例。其中畸形愈合2例（A3型与c1型各1例）。均经桡侧入路显露桡骨远端外侧柱、中柱、桡侧缘及其背侧，用LCP固定同时行背侧骨缺损植骨，最大限度恢复桡骨茎突高度、尺偏角及掌倾角。采用Gartland—Werley腕关节评分标准判定腕关节功能恢复情况。结果患者均获平均13．5个月（12—24个月）随访。术后定期复查X线片显示骨折均I期愈合，平均愈合时间为7．5周。术后6个月、1年和2年x线片测量：桡骨茎突短缩均≤2mm，掌倾角8°～17°（平均12．5°），尺偏角15°～26°（平均20．5°），关节面塌陷、移位矫正均≤2mm。术后患侧腕关节运动范围：掌屈30°～70°（平均60°），背伸30°～65°（平均55°），桡偏10°-20°（平均17°），尺偏20°～30°（平均25．5°），前臂旋前60°～70°（平均65．5°），旋后60°～80°（平均75．5°）。握力测量平均为健侧的75％（60％～95％）。伴有疼痛2例（其中中度疼痛与偶有轻度疼痛各1例）。根据Gartland—Werley腕关节评分标准：优16例，良2例，可2例，差1例，优良率为86％。术后无一例出现桡神经浅支支配区感觉异常，无感染、骨不连、钢板松动、正中神经损伤或肌腱损伤等并发症。结论桡侧入路可显露桡骨远端外侧柱、中柱、桡侧缘及其背侧，采用LCP固定同时行背侧骨缺损植骨，有助于骨折解剖复位，是治疗桡骨远端背侧不稳定骨折的有效方法。

Objective To investigate the clinical efficacy of fixation of distal radius fracture with dorsal instability with locking compression plate （LCP） via radial approach. Methods From September 2009 to October 2012, 21 cases underwent LCP fixation of the distal radius fracture with dorsal instability via radial approach. The study included 14 males and 7 females （mean age 54. 5 years ; range, 38-81 years）. Twelve cases were injured in traffic accidents, 7 in falls and 2 in high falls. Fracture AO classification was type A3 in 10 cases, type C1 in 8 cases and type C2 in 3 cases. Two cases （one type A3 and one type C1 ） had malunion. When the lateral column, intermediate column, radial edge and dorsal plane were exposed by radial incision, LCP fixation with hone grafting was performed to restore the height of radial styloid process, ulnar deviation and palmar tilt. According to the Gartland- Werley score, wrist joint function was evaluated. Results Mean duration of follow-up was 13.5 months （range, 12 to 24 months）. Stage I bone union was shown on X-rays, with the healing time of 7.5 weeks. Based on the X-rays at postoperative 6 months, 1 year and 2 years, the shortening of radial styloid process was ~〈 2 ram, mean volar tilt was 12.5°（ range, 8°-17°） , mean ulnar tilt was 20.5 ~ （range, 15°-26°） , and step-off or gap of the articular surface was ≤ 2 mm. In postoperative wrist motion assay, mean volar flexion was 60° （ range, 30°-70°） , mean dorsal flexion was 55°（ range, 30°-65° ） , mean radial deviation was 17°（ range, 10°-20~） , mean ulnar deviation was 25.5°（range, 20°-30°） , pronation was 65.5° （ range, 60°-70°） , and mean supination was 75.5°（ range, 60°-80°）. Mean grip strength was 75% （60% -95% ） of the contralateral side. Two eases suffered from pain （ one complained of moderate pain and one minor pain occasionally）. According to the Gartland-Werley score, 16 eases were rated excellent, 2 good, 2 fair and 1 poor, with the excellent rate of 86%. No complication was found as injury of the superficial branch of radial nerve, infection, nonunion, nail loosening, medium neuritis and tendon injury. Conclusions Lateral column, intermediate column, radial edge and dorsal plane can be shown via the radial approach. LCP fixation combined with bone grafting contributes to fracture anatomical reduction.