带袢钢板弹性固定修复远侧桡尺关节脱位

Loop plate elastic fixation for treatment of distal radioulnar joint dislocation

目的探讨带袢钢板弹性固定修复远侧桡尺关节损伤的临床效果。方法回顾性分析2014年12月至2016年11月期间采用带袢钢板弹性固定修复的12例远侧桡尺关节损伤患者资料。男7例，女5例；年龄为23。56岁，平均37．5岁。脱位类型：掌侧脱位2例，背侧脱位7例，横向脱位2例，纵向脱位1例。12例患者中合并尺骨骨折者6例，桡骨骨折者2例，尺桡骨双骨折者1例，均为闭合性骨折。末次随访时根据Gartland—Wefley腕关节评分系统、腕关节主动活动度及手握力来评价腕关节功能。结果12例患者术后获6～18个月（平均12个月）随访。术后腕关节正、侧位x线片示远侧桡尺关节脱位均获得复位。合并尺桡骨远端骨折者骨折均获愈合，愈合时间为2—5个月（平均3个月），远侧桡尺关节脱位均未复发。末次随访时根据Gaaland—Wedey腕关节评分系统评定腕关节功能：优10例，良1例，可1例；12例患者患侧腕关节主动屈伸、桡尺偏、旋前旋后活动度及手握力与健侧比较差异均无统计学意义（P〉0．05）。随访期间无一例患者发生伤口感染、皮肤坏死、内固定物失效、脱位复发及创伤性关节炎等并发症。1例患者出现尺侧软组织激惹，内固定物取出术后好转。结论带袢钢板弹性固定修复远侧桡尺关节损伤具有保留远侧桡尺关节生理微动、固定确切等优点，患者术后腕关节功能恢复良好，近期疗效满意。

Objective To observe the clinical efficacy of loop plate elastic fixation for treatment of distal radioulnar joint dislocation. Methods From December 2014 to November 2016, 11 patients with distal radioulnar joint dislocation were treated by loop plate elastic fixation. They were 7 males and 5 females, aged from 23 to 56 years （average, 37.5 years）. The dislocations were volar in 2 cases, dorsal in 7, transversal in 2 and longitudinal in one. Of them, 6 were complicated with ulnar fracture, 2 with radial fracture and one with radioulnar fracture. All the fractures were closed. Functional outcomes of the wrist were assessed by the Gart- land-Werley scoring system, range of motion and grip strength at the last follow-up. Results The 12 pa- tients were followed up from 6 to 18 months （average, 12 months）. Reduction of the distal radioulnar joint dislocation was confirmed in all by the anteroposterior and lateral X-ray films after operation. All the concomitant fractures were healed after 2 to 5 months （average, 3 months） . No re-dislocation of the distal radioulnar joint occurred. According to the Garland-Werley scoring at the last follow-up, the functional outcomes of the wrist were excellent in 10 patients, good in one and fair in one. There were no significant differences between the healthy and affected wrists in active range of flextion or extension, radial or unlnar deviation, pronation or supination, or grip strength （ P 〉 0. 05） . No infection, skin necrosis, internal fixation failure, dislocation recurrence or traumatic arthritis was observed during follow-up. The loop plate had to be removed in one case because of soft-tissue irritation. Conclusion Loop plate elastic fixation for distal radioulnar joint dislocation may pro- vide firm fixation as well as preserve physiological micro-motion of the joint, leading to fine functional recovery of the wrist and satisfactory short-term outcomes.