切开复位内固定治疗背侧脱位的Fernandez Ⅳ型桡骨远端骨折

Treatment of distal radius fractures with dorsal dislocation of Fernandez type Ⅳ by open reduction and internal fixation

目的探讨通过掌背侧联合入路切开复位内固定治疗背侧脱位的FernandezⅣ型桡骨远端骨折的手术方法和效果。方法回顾性分析自2010年7月至2016年6月北京积水潭医院创伤骨科通过掌背侧联合入路切开复位内固定治疗的14例背侧脱位的FernandezⅣ型桡骨远端骨折患者资料，均为男性，平均年龄38．4岁（27～52岁）。平均受伤至手术时间6．9d（4～10d）。左侧5例，右侧9例。分别在术后1、2、3、6、12个月随访摄正、侧位X线片并进行功能锻炼指导。术后6、12个月采用改良的Garland—Wefley评分法和患者自主评价腕关节评分法（PRWE）评定疗效。结果所有患者术后平均随访19．4个月（15～26个月），骨折均愈合良好，平均骨折愈合时间3．1个月（2～4个月）。术后6、12个月改良的Garland-Werley评分平均分别为8．9分（6～13分）、7．3分（4～11分）；PRWE评分平均分别为17．9分（12～25分）、16．5分（11．23分）。无一例患者发生感染、血管损伤及内固定失效等并发症。结论通过掌背侧联合入路切开复位内固定可以同时恢复桡骨远端背侧骨性结构的完整与腕关节掌侧韧带结构的稳定性，便于术后维持桡腕关节的稳定性，改善患者的功能，疗效满意。

Objective To report the treatment of distal radius fractures with dorsal dislocation of Fernandez type Ⅳ by open reduction and internal fixation via a combined dorsal and volar approach. Methods A retrospective analysis was conducted of the 14 cases of fresh distal radius fracture with dorsal dislocation of Fernandez type Ⅳ which had been treated by open reduction and internal fixation via a combined dorsal and volar approach at Department of Orthopaedic Trauma, Beijing Jishuitan Hospital from July 2010 to June 2016. All the patients were male, with an average age of 38.4 years （from 27 to 52 years）. The time from injury to surgery averaged 6.9 days （from 4 to l0 days）. Their injury involved 5 left and 9 right wrists. Follow-up was performed at 1, 2, 3, 6 and 12 months after operation when anteroposterior and lateral X-ray films were taken and functional exercise guidance was provided. At 6 and 12 months after operation, all the patients were evaluated using modified Gar]and-Werley scoring and Patient Rated Wrist Evaluation （PRWE）. Results The patients were followed up for an average of 19.4 months （from 15 to 26 months）. Their fractures healed well. Their fracture healing time averaged 3.1 months （from 2 to 4 months）. Their modified Garland-Werley scores at 6 and 12 months after surgery were 8.9 points （from 6 to 13 points） and 7.3 points （from 4 to 11 points）, respectively; their PRWE scores were 17.9 points （from 12 to 25 points） and 16. 5 points （from 11 to 23 points）, respectively. None of the patients was inflicted by infection, vascular injury or internal fixation failure. Conclusion The open reduction and internal fixation via a combined dorsal and volar approach can restore the stability of both the dorsal osseous structure of the distal radius and the volar ligament structure of the wrist, facilitating postoperative maintenance of the radioearpal joint stability, improving the wrist function and leading to satisfactory outcomes.