背侧入路楔形植骨治疗背伸成角型桡骨远端骨折畸形愈合

Wedge-shaped bone graft with dorsal approach for dorsal-angled malunion of distal radius fracture

目的总结背侧入路楔形植骨治疗背伸成角型桡骨远端骨折畸形愈合的疗效。方法采用背侧入路楔形植骨治疗17例背伸成角型桡骨远端骨折畸形愈合患者。测量并比较手术前后X线片上尺偏角、掌倾角、桡骨短缩的变化,观察并发症发生情况,比较术前及末次随访时腕关节DASH评分的变化。结果患者均获得随访,时间12~18个月。掌倾角、桡骨短缩术后第2天均较术前明显改善(P<0.01),尺偏角术后第2天与术前比较差异无统计学意义(P>0.05)。随访期间,2例患者腕关节旋后受限,1例患者切口红肿。未发生切口感染、植骨延迟愈合、尺骨撞击综合征及伸肌腱断裂等并发症。腕关节DASH评分由术前55~80(67.06±7.08)分改善至末次随访时10~20(15.00±3.54)分,差异有统计学意义(P<0.05)。结论背侧入路楔形植骨是治疗背伸成角型桡骨远端骨折畸形愈合的有效方法,临床效果满意。

Objective To summarize the curative efficacy of wedge-shaped bone graft with dorsal approach for dorsal-angled malunion of distal radius fracture.Methods The 17 cases with dorsal-angled malunion of distal radius fracture were treated with wedge-shaped bone graft surgery.Ulnar tilt angle,palmaris tilt angle,and shorten of radius on pre-and post-operative X-ray imaging films were measured and compared.Complications were observed.Preoperative DASH scales were compared with that at the last follow-up.Results All cases were followed up for 12~18 months.Compared with preoperative data,palmaris tilt angle and shorten of radius were significantly improved at 2 d postoperation(P<0.01),while there was no difference for ulnar tilt angles between preoperative and postoperative 2 d(P>0.05).During follow-up period,there were 2 cases of supination limitation,1 case of incision inflammation.Incision infection,delayed union of bone graft,ulna impact syndrome,and tendon break didn′t occurre.DASH scale of wrist improved from preoperative 55~80(67.06±7.08)points to postoperative 10~20(15.00±3.54)points,the difference was statistically significant(P<0.05).Conclusions Wedge-shaped bone graft with dorsal approach is an effective method for dorsal-angled malunion of distal radius fracture,with satisfactory clinical outcomes.