Henry入路锁定接骨板治疗不稳定型桡骨远端骨折的疗效分析

Volar locking plate for unstable distal radial fractures

目的 探讨掌侧锁定接骨板治疗不稳定型桡骨远端骨折的临床疗效.方法 回顾分析2011年1月-2014年12月,采用掌侧入路锁定接骨板治疗,并获得半年以上随访的128例不稳定型桡骨远端骨折病例.比较患者术后1个月,3个月,6个月Jakim桡骨远端骨折疗效评分及握力、关节活动度相对健侧的恢复程度.结果 128例在术后3个月内骨折均牢固愈合,无疼痛及严重并发症.术后6个月Jakim评分为优良者达到97％;术后1个月,3个月手部握力、腕关节活动度均较健侧有明显差异（P＜0.05）;术后6个月后,手部握力、腕关节活动度及功能评分均接近健侧水平（P＞0.05）,仅前臂旋后功能与健侧差异具有统计学意义（P=0.04）,但（54.4±21.9）°的旋后角度仍能满足日常生活需要.结论 对于桡骨远端骨折的治疗稳定性的判断是选择手术与非手术治疗的关键;掌侧入路锁定接骨板固定可用于绝大多数的桡骨远端骨折,并且更为可靠、有效、并发症更小;对于明显移位的尺骨茎突基底骨折应给予切开复位内固定.

Objective To evaluate the efficacy of the volar locking plate for unstable distal radial fractures. Methods 128 cases of unstable distal radius fractures were treated with volar locking plates and followed up more than 6 months from Jan 2011 to Dec 2014. Jakim efficacy scores of the distal radius fractures were compared and the grip strength and degree of motion between the healthy side and injured side were compared in 1 week, 1 month and 6months after the operations. Results All the 128 cases of fractures were healed within 4 months after operation, with no pain and serious complications. Rate of excellent and good was 97% measured by Jakim scale 6 months after the operation; the grip strength, wrist joint mobility have difference compared with the healthy side after 1 week and 1 month after the operation （P 〈 0.05）. The grip strength, wrist joint mobility were similar to the healthy side after 6 months of the operation （P 〉0.05）. Only the angle of forearm supination was statistically different from contralateral side （P = 0.04）, but （54.4±21.9）° supination can still meet the needs of daily life. Conclusion The unstable distal radial fractures can be treated effectively using locking plate fixation through volar approach, with little serious complications, the function of the wrist can recover to which before the injury.