骨瓣植骨联合外固定支架在青壮年桡骨远端骨折畸形愈合矫形中的应用

Correction of abnormal healing of distal radius fractures using bone flap graft and external fixation in young adul~

目的探讨骨瓣植骨联合外固定支架在开放截骨植骨复位治疗青壮年桡骨远端骨折畸形愈合的疗效。方法回顾性分析2012年7月至2015年9月收治的17例青壮年桡骨远端畸形愈合患者资料，男13例，女4例；年龄30～55岁，平均40．2岁；骨折分型：Colles骨折8例，Smith骨折5例，Bar-ton骨折4例；左侧7例，右侧10例。桡骨背侧开放截骨矫形、旋前方肌尺骨骨瓣植骨、剩余尺骨小头部分或全部切除及外固定支架联合克氏针固定。记录并比较术前与末次随访时患者患侧前臂旋前、旋后、背伸、掌屈、桡偏、尺偏、疼痛视觉模拟评分（VAS）及Cooney评分。结果17例患者术后获12～37个月（平均21．4个月）随访。术后无一例患者发生切口感染、皮缘坏死、骨板断裂、螺钉松动。术后x线片复查示桡骨远端截骨植骨全部愈合，愈合时间为8～20周，平均12周。末次随访时前臂旋前、前臂旋后、背伸角、掌屈角、掌倾角、尺偏角、VAS评分及Cooney评分较术前均有改善，差异有统计学意义（P〈0．05）。结论骨瓣植骨联合外固定支架固定是一种符合桡骨远端骨折畸形愈合矫形要求的手术方式，既能纠正畸形又能改善功能，具有简单、实用的特点，治疗效果满意。

Objective To evaluate the correction of abnormal healing of distal radius fractures using bone flap graft and external fixation in young adult patients. Methods A retrospective analysis of the clinical data was done for 17 young patients with abnormal healing of distal radius fracture who had been treated from July 2012 to September 2015 at our department. They were 13 males and 4 females, with an average age of 40. 2 years （range, from 30 to 55 years） . There were 8 Colles fractures, 5 Smith fractures and 4 Barton frac- tures. Seven cases were the left side and 10 the right side. The abnormal healing of fracture was corrected by open osteotomy through the dorsoradial approach, graft with a pronator quadratus ulnar flap, partial or complete excision of the remaining ulnar head, and external fixation combined with Kirschner wiring. The pronation, supination, dorsal extension, palmar flexion, radial deviation, ulnar deviation, Visual Analogue Scale （VAS） and Cooney scores were compared between preoperation and the final follow-ups. Results The 17 patients were followed up for 12 to 37 months （average, 21.4 months）. No incision infection, skin margin necrosis, plate breakage, or screw loosening occurred. The postoperative X-rays revealed union of all the bone grafts at the distal radius after 8 to 20 weeks after operation （average, 12 weeks）. The symptoms of the wrist joint were significantly relieved. The final follow-ups showed significant improvements in pronation, supination, dorsal extension, pal- mar flexion, radial deviation, ulnar deviation, VAS and Cooney scores （ P 〈 0.05） . Conclusion Ab- normal healing of distal radius fractures can be effectively corrected using bone flap graft and external fixation in young adult patients, because this simple but practical operation not only corrects the deformity but also improves function satisfactorily.