外固定架结合有限内固定治疗中青年桡骨远端C3型骨折

External fixation combined with limited internal fixation in treatment of middle-aged and young type C3 of distal radius fractures

目的探讨外固定架结合克氏针有限内固定治疗中青年桡骨远端C3型骨折的手术技巧及临床疗效。方法采用闭合撬拨复位或掌侧、背侧、掌背联合有限切开复位克氏针内固定结合外固定架治疗25例中青年桡骨远端C3型骨折患者,术前完善腕关节X线检查及CT平扫+三维重建,软组织条件改善后手术治疗。5例采用闭合复位;20例采用有限切开复位,其中单纯背侧有限切开4例,单纯掌侧有限切开7例,掌侧联合背侧有限切开9例。结果 25例均获得随访,时间12~24个月。骨折均愈合,时间10~20周。针道浅表感染3例,给予局部换药后治愈;早期部分克氏针松动3例,进一步随访未发现脱出;1例开放骨折术后出现伤口深部感染,经换药等处理后伤口延迟愈合。均无外固定架松动及医源性骨折等发生。根据腕关节Dienst et al功能评估标准评定疗效:优16例,良5例,可3例,差1例。结论对于中青年桡骨远端C3型骨折,灵活选择闭合撬拨复位或掌侧、背侧、掌背侧联合有限切开复位外固定架结合多枚克氏针内固定,创伤小,复位好,固定可靠,可取得较好疗效。

Objective To discuss the surgical techniques and clinical curative effect of the treament of distal radius fracture of middle-aged and young with limited open reduction and wires internal fixation combined with external fixation.Methods Closed poking reduction,volar and/or dorsal limited open reduction and Kirschner wire internal fixation combined with external fixation were used to treat 25 cases of young and middle-aged of type C3 fractures of the distal radius,the wrist X-rays and CT scan＋3D reconstruction were performed in all patients before surgery,and then underwent surgical treatment after improvement of soft tissue condition.There were 5 cases with closed reduction;20 patients with limited open reduction,including 4 cases of simple dorsal incision limited,7 cases of pure limited volar incision,9 cases of volar joint dorsal incision.Results All the 25 patients were followed up for 12~24 months,and got bone union in 10~20 weeks.Three cases were infected with superficial sinus pin,and they were cured by local wound dressing.There were 3 cases of Kirschner wire loosening at the early time,but were not found prolapsing at the further follow-up.There was 1 case of open fractures deep wound to be infected after operation,which was delayed healing by wound dressing.According to Dienst et al functional evalution standard,the wrist joint function evalation was excellent in 16 cases,good in 5,fair in 3 and poor in 1.Conclusions For young and middle-aged of type C3 fractures of the distal radius,flexible choice closed poking reduction,volar and/or dorsal limited open reduction and wires internal fixation combined with external fixation treatment,small trauma,good reduction,fixation is reliable,good curative effect can be obtained.