过伸位牵引掌侧撬拔复位植骨内固定治疗桡骨远端FernandezⅢ型骨折

Open pulling reduction and bone graft by overstretched wrist traction and internal fixation for the treatment of distal radius type FernandezⅢfractures

目的:探讨过伸位牵引掌侧撬拔复位植骨内固定治疗桡骨远端FernandezⅢ型骨折的临床疗效。方法:自2017年2月至2018年3月采用术中过伸位牵引掌侧撬拔复位植骨内固定治疗桡骨远端FernandezⅢ型骨折患者11例,男6例,女5例;年龄55~67岁。术前X线片及CT评估桡骨远端骨折背侧成角伴关节面压缩、塌陷。按Fernandez分型均为Ⅲ型。术后评估关节面复位情况,观察骨折愈合情况,随访采用VAS评分及Cooney腕关节评分量表评估疗效。结果:全部患者无手术并发症的发生,11例患者术后均获随访,时间12~14个月,骨折全部愈合。Cooney腕关节评分量表评估疗效,优9例,良1例,可1例。结论:桡骨远端FernandezⅢ型骨折术中采用过伸位牵引加大成角,经掌侧骨折端撬拔复位植骨内固定能有效的复位塌陷的关节面并给予有效固定,术后早期功能锻炼,临床效果满意。

Objective:To explore the clinical effect of the treatment of Fernandez typeⅢfracture of the distal radius with hyperextension traction prying,volar reduction,bone grafting and internal fixation.Methods:From February 2017 to March 2018,11 cases of Fernandez typeⅢfracture of the distal radius were treated with intraoperative hyperextension traction and volar prying reduction and bone grafting and internal fixation,including 6 males and 5 females,aged 55 to 67 years.Preoperative X-ray and CT evaluated the distal radius fracture dorsal angulation with articular surface compression,collapse.According to Fernandez,all of them were typeⅢ.After operation,the reduction of articular surface and fracture healing were evaluated.VAS score and Cooney wrist score were used to evaluate the curative effect.Results:All the patients were followed up for 12 to 14 months.All the fractures healed.Cooney wrist score scale was used to evaluate the curative effect,9 cases were excellent,1 case was good and 1 case was fair.Conclusion:In the operation of Fernandez typeⅢfracture of the distal radius,hyperextension traction was used to enlarge the angle,and through the volar fracture end prying reduction and internal fixation with bone graft,the collapsed articular surface could be effectively reduced and fixed.The early functional exercise after the operation had satisfactory clinical effect.