截骨延长髂骨植骨治疗桡骨远端陈旧性骨折并下尺桡关节脱位

Osteotomy extension iliac bone graft to treat the delayed distal radius fracture and distal radioulnar joint dislocation

目的探讨截骨延长、髂骨块植骨加锁定钢板治疗桡骨远端陈旧性骨折并下尺桡关节脱位的方法及疗效。方法对30例桡骨远端陈旧性骨折短缩畸形伴下尺桡关节脱位的患者行截骨延长加髂骨块植骨、桡骨远端锁定钢板内固定治疗。结果 30例均获得随访,时间12~15个月。患者腕关节前屈、后伸、尺偏、桡偏、旋前和旋后功能较术前均明显改善（P〈0.05）,术后桡骨短缩、掌倾角及尺偏角与术前比较差异均有统计学意义（P〈0.05）。根据Garland-Werley功能评定：优21例,良5例,可2例,差2例,优良率86.7%。术后未出现桡骨高度丢失、内固定失败及骨不连等并发症。结论截骨延长、髂骨块植骨加锁定钢板治疗桡骨远端陈旧性骨折并下尺桡关节脱位有利于恢复腕关节的正常解剖结构,明显改善腕关节功能,减少创伤性关节炎的发生。

Objective To investigate the methods and curative effects of the radial extension,iliac bone graft plus locking plate to treat the delayed distal radius fracture and distal radioulnar joint dislocation. Methods 30 patients with distal radius delayed fractures malunion and distal radioulnar joint dislocation were treated by radial extension plus iliac bone graft and locking plate internal fixation of distal radius. Results All of 30 patients were followed up for 12 ~ 15 months. There were all patents improvements in the functions of wrist flexion,stretching,ulnar deviation,radial deviation,pronation and supination after operation; the mean shorten length,tilt of the radius,and radial inclination,and the comparative differences between the preoperative and postoperative had statistically significance（ P〈0. 05）. According to the Garland-Werley functional assessment： 21 cases were excellent,5 good,2 fair,2 poor,the rate of excellent and good was 86. 7%. No complications like radial height loss,fixation failure and nonunion after operation were found. Conclusions Osteotomy extension iliac bone graft and locking plate for the delayed distal radius fracture and distal radio ulnar joint dislocation makes for restoring the normal anatomy of the wrist,improves the wrist function obviously,and reduces the incidence of traumatic arthritis.