采用内固定方法治疗桡骨远端合并同侧腕舟骨骨折的疗效

Clinical evaluation of surgical internal fixation of ipsilateral fractures of the distal radius and scaphoid

目的分析手术内固定治疗桡骨远端合并同侧腕舟骨骨折的临床疗效。方法 2014年7月至2017年6月期间上海交通大学附属第六人民医院创伤骨科符合桡骨远端合并同侧腕舟骨骨折的29例手术患者资料,年龄20~71(39.4±13.3)岁,其中男24例,女5例。桡骨远端骨折(新AO分型)23-A型4例,23-C型25例。腕舟骨骨折(Herbert-Fischer分型)均为B2型骨折。桡骨远端骨折采用手术切开复位内固定,腕舟骨骨折则采取闭合复位内固定。临床疗效采用Cooney腕关节评分进行术后评估。结果所有患者随访时间12~26(16.8±4.1)个月。两处骨折患者均达到骨性愈合,无术后相关并发症。其中桡骨远端骨折平均愈合时间(8.8±2.0)周,腕舟骨平均愈合时间(13.6±3.6)周。患侧腕关节主动活动度平均为背伸45.3°±11.6°、掌屈42.2°±8.4°、旋前82.2°±8.3°、旋后61.6°±14.4°。末次随访Cooney腕关节评分方法为(74.3±16.1)分,总体优良率44.8%(13/29)。结论手术内固定治疗桡骨远端合并同侧腕舟骨骨折有助于骨折愈合及腕关节早期功能康复,总体疗效良好。

Objective To investigate clinical effect of surgical internal fixation of the ipsilateral distal radius fractures(DRFs) and scaphoid fractures(SFs). Methods A data ofpatients with concurrent fractures of the distal radius and scaphoid was reviewed in Department of Trauma Orthopaedics, Shanghai Sixth People’s Hospital from July 2014 to June 2017. Among these patients, 24 males and 5 females,mean age 39.4±13.3(range:20-71) years. New AO classification for DRFs:type 23-A in 4 cases,type 23-C in 25 cases. Herbert-Fischer classification for SFs:type B2 in all cases. All patients with DRFs were treated by open reduction and internal fixations, while all patients with SFs by closed reduction and internal fixations. The function of the injured wrist was assessed by Cooney Score. Results All of the 29 patients were followed up for 12 to 26 months with an average of 16.8±4.1 months.All patients withDRFs and SFs were cured without any surgical complications.The mean time of DRFs union was 8.8±2.0 weeks, while SFs was 13.6±3.6 weeks.The mean rangeof active extension motions of wrist were 45.3°±11.6°, the mean range of flexion 42.2°±8.4 °, the mean range of pronation 82.2° ±8.3°, and the mean range of supination 61.6°±14.4°. At last follow-up time,the mean Cooney score were 74.3±16.1 scores. The excellent and good rate is 44.8%(13/29). Conclusion Surgical reduction and internal fixation for these injuries of combined ipsilateral fractures of distal radius and scaphoidare useful, and could obtaina early functional recovery of wrist joint.