切开复位经骨窗植骨内固定治疗桡骨远端B4型骨折

Open reduction and bone graft with internal fixation through bone window for the treatment of type B4 distal radius fractures

目的:探讨切开掌侧经骨窗撬拨复位植骨内固定治疗桡骨远端B4型骨折的临床疗效。方法:自2015年1月至2016年6月,采用切开掌侧经骨窗撬拨复位植骨内固定治疗桡骨远端B4型骨折患者13例,男9例,女4例;年龄18～36岁,平均26.3岁。骨折按AO/OTA分型为B4型。观察骨折愈合、术后并发症情况,并于术后12个月时采用VAS评分评价其疼痛缓解程度,采用Cooney腕关节评分对患者术后功能恢复情况进行评价。结果:13例患者术后获随访,时间10～14个月,平均12.4个月。骨折全部愈合,时间4～6个月,平均5.2个月。术后12个月Cooney腕关节评分,优10例,良2例,可1例。VAS评分为1.0±1.1,握力占健侧比率(88.2±2.7)%,掌倾角(12.2±3.8)°,尺偏角(19.3±5.4)°,腕关节屈伸活动度(118.1±2.3)°,前臂旋转活动度(158.0±13.0)°。术后无骨关节炎发生及相应并发症发生。结论:采用经掌侧骨窗撬拨复位植骨内固定治疗桡骨远端B4型中舟月关节面塌陷压缩型骨折,临床效果满意,术后并发症少,是治疗此类骨折的有效方法之一。

Objective：To explore clinical effect of open reduction and bone graft with internal fixation through bone window for the treatment of type B4 distal radius fractures. Methods：From January 2015 to June 2016,13 patients with type B4 distal radius fractures treated with bone graft with internal fixation through bone window,including 9 males and 4 females aged from 18 to 36 years old with an average of 26.3 years old. Fractures were classified to type B4 according to AO/OTA classification. Fracture healing and postoperative complication were observed,VAS score was used to evaluate pain,and Cooney wrist scoring was applied to evaluate recovery of function. Results： All patients were followed up from 10 to 14 months with an average of 12.4 months. Fracture healed from 4 to 6 months with an average of 5.2 months. According to Cooney wrist scoring,10 got excellent results,2 good and 1 moderate. VAS score was 1.0±1.1,grip strength of contralateral ratio was（88.2±2.7）%,palmer tilt angle was（12.2±3.8）°,ulnar drift angle was（19.3±5.4）°,wrist flexion mobility was（118.1±2.3）°,forearm rotation motion was（158.0 ±13.0）°. No osteoarthritis occurred and symptoms occurred during follow-up. Conclusion：Open reduction and bone graft with internal fixation through bone window for the treatment of type B4 distal radius fractures,which has advantages of satisfied clinical effects,less complications,is one of the effective method for type B4 distal radius fractures.