Ilizarov延长技术关节外截骨治疗桡骨远端骨折后短缩畸形

Efficacy of Ilizarov’s extension technique extra-articular osteotomy on shortening deformity after distal radius fracture

背景:治疗桡骨远端骨折后短缩畸形方式多样,疗效不一,Ilizarov延长技术适合治疗桡骨远端骨折后短缩畸形。目的:探讨应用Ilizarov延长技术关节外截骨治疗桡骨远端骨折后短缩畸形的疗效。方法:我院从2011年8月至2019年8月,应用Ilizarov延长技术关节外截骨治疗桡骨远端骨折后短缩畸形11例。其中男8例,女3例;左7例,右4例;年龄14~36岁,平均(24.5±7.8)岁。根据Ilizarov外固定穿针原则,安装外固定支架,在桡骨远端距关节面20 mm处截骨,手术后7 d以0.75 mm/d速度旋转螺母,分4次延长桡骨,逐渐恢复桡骨的高度,调整铰链矫正尺偏角及掌倾角。结果:11例患者随访8~33个月,平均(20.0±11.9)个月;带外固定时间为(5.0±1.9)个月。拍摄双侧尺桡骨正侧位片(包括腕、肘关节),以肱骨外髁、桡骨茎突为两点连线,对比测量出桡骨短缩长度。术前桡骨平均短缩-31.5(-37.0,-30.0)mm,术后长度恢复32.0(30.0,38.0)mm,差异有统计学意义(P<0.05),符合桡骨长度恢复要求。术后桡骨掌倾角和尺偏角大于术前[12.0°(10.0°,13.0°)vs.-10.0°(-17.0°,-4.0°);21.5°(20.0°,24.0°)vs.-18.5°(-26.0°,-10.0°)];术后腕关节背伸和掌屈大于术前[(50.0°±4.9°)vs.(45.0°±7.1°);(55.0°±4.0°)vs.(50.0°±5.3°)];术后前臂旋前活动度和旋后活动度大于术前[(68.0°±7.2°)vs.(65.0°±8.3°);(66.0°±6.5°)vs.(60.0°±9.1°)];Quick-DASH上肢功能障碍量表评分,术后为2.3(0.0,4.5)分,小于术前29.5(22.7,52.3)分(P均<0.05),符合矫形恢复要求。根据Lidstrom腕关节功能评分标准评定:优8例,良2例,可1例。结论:Ilizarov延长技术关节外截骨是治疗桡骨远端骨折后短缩畸形的有效手段。

Background: The treatment of shortening deformity after distal radius fracture is varied and has different effects,and Ilizarov’s extension technique is an effective method. Objective: To investigate the effect of Ilizarov’s extension technique on shortening deformity after distal radius fracture. Methods: A total of 11 patients with shortening deformity after distal radius fractures were treated by Ilizarov’s extension technique of extra-articular osteotomy from August 2011 to August 2019, including 8 males and 3 females and 7 left arms and 4 right arms, with the mean age(24.5±7.8) years(range, 14-36). Following the Ilizarov’s external fixation kirschner wire principle, an external fixed bracket was installed and the bone was cut at a distance of 20 mm from the surface of the distal part of the radius. From 7 days after surgery, the rotating nut extended the radius at a speed of 0.75 mm/d for 4 times, gradually restoring the height of the radius. Hinge was adjusted to correct the radial tilt and the radial inclination. Results: All patients were followed up for(20.0±11.9) months(range, 8-33), and wore external fixator for(5.0±1.9) months. Preoperative radius shortening was-31.5(-37.0,-30.0) mm, and postoperative length recovery was 32.0(30.0, 38.0) mm(P<0.05), which met the requirements of shortening length recovery. The postoperative angle of the radial metacarpal inclination(12.0°[10.0°, 13.0°]) and the postoperative ulnar deviation angle(21.5°[20.0°, 24.0°]) increased compared with that before operation(-10.0°[-17.0°,-4.0°],-18.5°[-26.0°,-10.0°]);the postoperative dorsal extension of wrist joint(50.0°±4.9°) and metacarpal flexion(55.0°±4.0°) were greater than that before operation(45.0°±7.1°, 50.0°±5.3°);the pronation(68.0°±7.2°) and the supination(66.0°±6.5°) of forearm after operation were greater than that before operation(65.0°±8.3°, 60.0°±9.1°, all P<0.05). The score of Quick-DASH upper limb dysfunction scale(2.3[0.0,4.5]) after operation was less than that before operation(29.5[22.7,52.3],P<0.05). According to the Lidstrom wrist function score, there were 8 patients excellent, 2 patients good and 1 patient acceptable. Conclusions: Ilizarov’s technique of extra-articular osteotomy is an effective method in treatment of shortening deformity after distal radius fractures.