手术治疗桡骨远端陈旧性die-punch骨折

Surgical treatment of old die-punch fractures of distal radius

目的探讨手术治疗桡骨远端陈旧性die-punch骨折的疗效。方法回顾性分析2012年1月至2017年1月山东大学附属省立医院骨科收治的21例陈旧性die-punch骨折患者资料。男13例，女8例；年龄34—63岁，平均46．9岁。通过术前X线片和CT确诊，根据骨折块位置分为掌侧压缩骨折14例和背侧压缩骨折7例；术中采用掌侧人路13例，背侧入路7例，联合入路1例，均行自体髂骨植骨填充支撑。记录患者术前、末次随访时Cooney腕关节功能评分、疼痛视觉模拟评分（VAS）及术后并发症发生情况等。结果21例患者术后获8—14个月（平均9．2个月）随访。所有患者术后伤口均一期愈合。术前与末次随访时患者Cooney腕关节功能评分分别为（58．5±4．2）、（84．0±3．1）分，疼痛VAS评分分别为（7．6±0．9）、（3．4±1．3）分，以上项目术前与末次随访时比较差异均有统计学意义（P〈0．05）。术后1例患者发生腕关节炎。结论手术治疗桡骨远端陈旧性die-punch骨折能明显减轻疼痛、改善患者腕关节功能、提高生活质量。

Objective To report the effects of surgical treatment of old die-punch fractures of the distal radius. Methods A retrospective study of case series was made of the 21 old die-punch fractures of the distal radius which had been surgically treated from January 2012 to January 2017 at Department of Orthopaedics, Shandong Provincial Hospital. There were 13 males and 8 females, aged from 34 to 63 years （average, 46. 9 years） . According to the preoperative definite diagnoses by the X-ray and CT images, there were 14 metacarpal compression fractures and 7 dorsal compression fractures. The palmar approach was used in 13 cases, the dorsal approach in 7 and the combined approach in one. Autogenous iliac bone grafting was performed for all the cases. Their preoperative and postoperative Cooney scoring and visual analogue scale （VAS） of the wrist, and postoperative complications as well, were observed and recorded. Results This cohort was followed up for 8 to 14 months （average, 9.2 months）. All their postoperative wounds healed by the first intention. Their Cooney functional scores of the wrist were, respectively, 58.5±4. 2 and 84.0± 3.1 points preoperatively and at the final follow-up, and their corresponding VAS scores 7.6±0. 9 and 3.4± 1.3 points, showing significant differences between preoperation and the final follow-up （ P 〈 0. 05） . Carpal arthritis was observed in one case. Conclusion For old die-punch fractures of the distal radius, surgical treatment can obviously reduce pain, improve function of the wrist and enhance the quality of life of the patients.