关节镜辅助下克氏针结合外固定支架治疗桡骨极远端骨折疗效观察

Effectiveness of arthroscopy-assisted combined fixation of Kirschner wire and external fixator for treating extreme distal radial fractures

目的探讨关节镜辅助下克氏针结合外固定支架治疗桡骨极远端骨折的临床效果。方法 2014年1月—2016年5月,采用腕关节镜辅助下克氏针结合外固定支架治疗桡骨极远端骨折21例。其中男14例,女7例;年龄32~57岁,平均42.3岁。致伤原因:摔伤13例,交通事故伤8例。骨折按AO/OTA分型:23C1型8例,23C2型9例,23C3型4例。受伤至手术时间3~7 d,平均4.4 d。采用腕关节Mayo评分及上肢功能调查量表(DASH)对患者腕关节疼痛、关节功能进行评估。结果术后无针道红肿、肌腱激惹等早期并发症发生。所有患者均获随访,随访时间10~35个月,平均18.3个月。骨折愈合时间9~13周,平均10.6周。随访期间患者均无慢性腕关节疼痛及腕关节炎表现。末次随访时腕关节Mayo评分为87~94分,平均90.9分,其中优17例、良4例;腕关节功能DASH评分为7~13分,平均10.6分。结论关节镜辅助下克氏针结合外固定支架治疗桡骨极远端骨折具有固定牢靠、便于患者早期功能锻炼、术后并发症少等优点,术后腕关节功能恢复良好。

Objective To investigate the effectiveness of arthroscopy-assisted combined fixation of Kirschner wire and external fixator for treating extreme distal radial fractures. Methods Between January 2014 and May 2016, 21 patients who suffered from extreme distal radial fractures were treated by arthroscopy-assisted combined fixation of Kirschner wire and external fixator. There were 14 males and 7 females with an age of 32-57 years （mean, 42.3 years）. The causes of injury included falling in 13 cases and traffic accident in 8 cases. The fracture type included 8 cases of type 23C1, 9 cases of type 23C2, and 4 cases of type 23C3 according to AO/OTA classification. The time from injury to operation was 3-7 days （mean, 4.4 days）. The Mayo score and disability of arm, shoulder, and hand （DASH） score were used to assess the pain and function of the wrist joint. Results There was no needle red swelling, tendon irritation, or orther early complications. All the patients were followed up 10-35 months （mean, 18.3 months）. The fracture healing time was 9-13 weeks （mean, 10.6 weeks）. At last follow-up, the Mayo score was 87-94 （mean, 90.9）; and 17 cases were excellent and 4 were good. The DASH score was 7-13 （mean, 10.6）. Conclusion Arthroscopy-assisted combined fixation of Kirschner wire and external fixator for treating extreme distal radial fractures has the advantages of firm fixation, early functional exercise, less postoperative complications, and good functional recovery of wrist joint.