改良Doi分型指导关节镜下辅助复位的临床应用价值研究

Clinical application value study of arthroscopic assisted reduction guided by modified Doi classification

目的探讨改良Doi分型指导腕关节镜下辅助复位的临床应用价值。方法自2014年至2018年我科行桡骨远端关节内骨折关节镜下镜检及辅助复位患者共79例,均先行切开复位内固定,然后关节镜检查骨折复位情况。对首次复位后关节面出现>1 mm台阶的骨折类型,依据前期研究的“改良Doi分型”进行分类,在关节镜下对移位的骨折块进行复位,找出首次复位后容易出现骨折移位的类型。结果术前79例患者的分型:两部分水平型11例,两部分垂直型13例,两部分背侧边缘型2例,两部分尺背侧型18例,两部分尺掌侧型1例,三部分型12例,四部分型22例。术中关节镜探查发现首次复位后21例出现关节面存在>1 mm的台阶,分别为两部分水平型2例、两部分尺背侧型7例、三部分骨折4例、四部分骨折8例。结论改良Doi分型中,两部分、三部分及四部分型骨折中有尺背侧骨块,在首次复位后有超过30%的概率出现>1mm的移位,需要关节镜辅助复位。

Objective To investigate the clinical value of modified Doi classification in guiding arthroscopic assisted reduction.Methods From 2014 to 2018,a total of 79 patients with intra-articular distal radius fractures underwent arthroscopic examination and assisted reduction.All the patients underwent open reduction and internal fixation first,and then arthroscopic examination of fracture reduction was conducted.According to the modified Doi classification of the previous study,the fracture types with>1 mm steps on the articular surface after the first reduction were classified,and the displaced fracture blocks were reduced under arthroscopy to find out the types of fracture displacement prone to occur after the first reduction.Results The preoperative classification of 79 patients:11 cases of two-part horizontal type,13 cases of two-part vertical type,2 cases of two-part dorsal marginal type,18 cases of two-part ulnar dorsal type,1 case of two-part ulnar palmar type,12 cases of three part type and 22 cases of four part type.The intraoperative arthroscopic exploration showed that 21 cases had steps>1 mm on the articular surface after the first reduction,including 2 cases of two-part horizontal type,7 cases of two-part dorsal ulnar type,4 cases of three-part fracture and 8 cases of four-part fracture.Conclusion In the modified Doi classification,there are two-part,three-part and four-part fractures with dorsal ulnar bone mass,and there is more than 30%probability of displacement>1 mm after the first reduction,which requires arthroscopic reduction.