腕关节镜辅助下Kapandji技术整复桡骨远端Die-punch塌陷型骨折

Application of Kapandji technique assisted by wrist arthroscopy for the treatment of Die-punch collapse fracture of distal radius

目的探讨腕关节镜辅助下Kapandji技术整复桡骨远端Die-punch塌陷型骨折的治疗效果。方法自2012年1月至2018年12月,我们共收治31例桡骨远端Die-punch塌陷型骨折患者,骨折均经CT检查确诊,术中在腕关节镜视下用克氏针撬拨复位桡骨远端塌陷骨折块,达到关节软骨面基本平整,进一步检查腕关节内韧带,特别是舟月韧带、月三角韧带和三角纤维软骨复合体的损伤情况,并修复相应韧带损伤。本组骨折均用克氏针结合外固定支架固定。结果术中发现合并舟月韧带损伤5例、月三角韧带损伤2例、三角纤维软骨复合体损伤10例。术后患者伤口均Ⅰ期愈合,并获得随访,时间为6~24个月,平均11.3个月。骨折愈合时间为6〜8周,平均7周。术后X线片测量掌倾角6°~17°,尺偏角15°~23°。腕关节功能按Gartland-Werley标准评定:优22例,良7例,可2例,优良率为93.5%。结论腕关节镜辅助下Kapandji技术整复桡骨远端Die-punch塌陷型骨折可准确复位塌陷的关节面,可减少创伤性骨关节炎并发症,又能明确腕关节内韧带和三角纤维软骨复合体等结构的损伤程度,便于早期处理,以防遗留慢性腕关节痛或不稳定。

Objective To explore the clinical efficacy of Kapandji technique assisted by wrist arthroscopy for the treatment of Die-punch collapse fracture of distal radius.Methods From January 2012 to December 2018,31 patients with Die-punch collapse fracture of distal radius were treated.All the fractures were confirmed by CT examination.During the operation,Kirschner wire was used to pry for the reduction of the collapsed fracture block of distal radius under wrist arthroscopy to achieve the smooth articular cartilage surface.The internal ligaments of wrist joint,especially scapholunate ligament,lunatotriquetral ligament and triangular fibrocartilage complex,were further examined and repaired.All the fractures were fixed with Kirschner wire and external fixator.Results During the operation,there were 5 cases of scapholunate ligament injury,2 cases of lunatotriquetral ligament injury and 10 cases of triangular fibrocartilage complex injury.All the patients achieved primary healing and were follow-up for 6 to 24 months with an average of 11.3 months.The fracture healing time was 6 to 8 weeks with an average of 7 weeks.The palmar inclination angle with 6°to 17°and the ulnar deviation angle was 15°to 23°by measuring the postoperative X-ray films.According to Gartland-Werley evaluation criteria,22 cases were excellent,7 cases were good and 2 cases were fair.The excellent and good rate was 93.5%.Conclusion The recovery of Die-punch collapse fracture of distal radius by Kapandji technique assisted with arthroscopy can accurately reduce the collapsed joint surface,reduce the complications of traumatic osteoarthritis,and also clarify the damage degree of the structure of the ligament and triangular fibrocartilage complex of the wrist joint,which is convenient for early treatment,so as to prevent chronic wrist pain or instability.