经桡侧入路治疗桡骨远端不稳定骨折的疗效分析

Treatment efficacy analysis of unstable distal radius fractures through the radial approach

目的探讨经桡侧入路治疗桡骨远端不稳定骨折的可行性及临床疗效。方法自2009年1月至2015年6月，我们经桡侧入路治疗桡骨远端不稳定骨折患者27例。按AO分型，A3型11例，C1型9例，C2型7例。术中经桡侧入路显露骨折外侧柱、中柱、桡侧缘及背侧，锁定钢板固定，同时行背侧缺损植骨，最大限度恢复桡骨茎突高度、尺偏角及掌倾角，牢固固定并行早期功能锻炼。结果术后随访时间为12～24个月，平均1413个月，骨折均愈合，平均时间为73周。根据Gartland—Werley腕关节评分标准评定：优19例，良6例，可1例，差1例，优良率为92．6％。结论经桡侧入路可以安全显露桡骨远端外侧柱、中柱、桡侧缘及背侧，可通过一个切口完成掌背侧固定及背侧骨缺损植骨，有助于骨折解剖复位及牢固固定，是治疗桡骨远端背侧不稳定骨折的有效方法。

Objective To investigate the feasibility and clinical effects of the treatment of unstable radius fractures through the radial approach. Methods From January 2009 to June 2015, 27 patients with unstable radius fractures were treated in our department. According to the AO classification, 11 cases were type A3, 9 cases were type C1 and 7 cases were type C2. The lateral column, middle column, radial margin, and dorsal side of fractured distal radius were exposed through the radial approach. Locking plate fixation and dorsal bone graft were conducted to maximally restore the height of styloid process of radius, angles of ulnar deviation and palmar flit. Firm fixation was achieved for early functional exercise. Results Postoperative follow-up period ranged from 12 to 24 months （mean, 14.3 months）. All the fractures were united. The mean healing time was 7.3 weeks. According to Gartland-Werley wrist scoring standard, the results were excellent in 19 cases, good in 6 cases, fair in 1 case, poor in 1 case, with the excellent and good rate being 92.6%. Conclusion It can be safe to expose the lateral column, middle column, radial margin, and dorsal side of fractured distal radius through the radial approach. Volar and dorsal fixation and dorsal bone graft were finished only through one incision, which is helpful to achieve anatomical reduction and firm fixation of fractures. It is an effective method to treat the dorsal unstable distal radius fractures.