微型钢板内固定治疗桡骨远端关节内和近关节骨折

Treatment of mini-plate for intra-articular and juxta-articular fractures of distal radius

目的探讨微型钢板内固定治疗不稳定桡骨远端关节内和近关节骨折的方法及效果。方法回顾性分析了自2008—01—2012一01采用2．0mm微型钢板内固定治疗的72例（76侧）关节内及骨折线接近关节面的桡骨远端不稳定骨折，采用单一微型钢板内固定22侧，双微型钢板内固定26侧，微型钢板与T形钢板内固定19侧，微型钢板与锁定钢板内固定9侧。结果72例术后获得平均18．5（12～30）个月随访。末次随访时掌倾角由术前平均-7.3°改善至术后7．40．尺偏角由术前平均15．1°改善至术后22．2°，桡骨高度由术前平均7．9mm改善至术后12．4mm。影像学评分采用Stewart改良的Sarmiento标准评估：优59侧，良12侧，可5侧，优良率93．4％。腕关节功能按Gartland—Werley评分标准评估：优53侧，良14侧，可9侧，优良率88．2％。结论微型钢板内固定是治疗桡骨远端关节内和近关节骨折的有效方法，可灵活固定复杂骨折，软组织干扰少，能满足早期活动的需要。

Objective To explore the method and the effect of mini-plate for the treatment of intra-articular and juxta- articular fractures of distal radius. Methods Seventy two patients with 76 fractures of intra-arficular and juxta-articular fractures of distal radius treated with mini-plate from January 2008 to January 2012 at our center were reviewed retrospectively. There were 22 cases fixed with single mini-plate, 26 cases fixed with double mini-plate, 19 cases fixed with mini-plate and T-plate, 9 cases fixed with mini-plate and locking compression plate. Results All patients were successfully followed up for 12 to 30 months with an average of 18.5 months. The volar tilt increased from a mean of -7.3° to 7.4°. The radial inclination increased from a mean of 15.1° to 22.2°. The radial length increased from a mean of 7.9 to 12.4 mm. The radiographic manifestation was rated as excellent in 59 patients, good in 12 and fair in 5 according to the Sarmiento scale. Garland-Werley functional assessment rated wrist function to be excellent in 53 patients, good in 14 and fair in 9, with the excellent and good rate of 88.2%. Conclusion Mini-plate fixation is an effective method for treatment of intra-articular and juxta-articular fractures of distal radius, which provides more flexible fixation of complex fracture, less irritation of soft tissue and allows early function exercise.