牵引钢板联合Masquelet技术治疗桡骨远端粉碎性骨折伴骨缺损临床分析

Traction Plate Combined with Masquelet Technique for Treatment of Distal Radius Comminuted Fractures with Bone Defects

目的探讨牵引钢板联合骨水泥诱导膜(Masquelet)技术治疗桡骨远端粉碎性骨折伴骨缺损临床疗效.方法2例桡骨远端粉碎性骨折伴骨缺损患者Ⅰ期行外固定架固定,并在骨缺损处填充万古霉素骨水泥,使其产生Masquelet膜.后期拆除外固定架,通过第3掌骨、腕关节、桡骨远端背侧切口应用牵引钢板跨过骨折区进行植骨.结果2例均获得随访15个月.2例患者取出钢板后伤手屈伸功能恢复,复查X线显示桡骨骨折及缺损区愈合良好,骨密度影增高.术后6个月两例患者DASH评分分别为31分和39分;术后9个月分别为24分和27分;术后12个月分别为18分和21分;拆除钢板后末次随访(15个月)分别为16分和18分.末次随访时Gartland-werley评分两例皆良.结论牵引钢板联合Masquelet技术治疗桡骨远端粉碎性骨折伴骨缺损具有稳定强性、感染风险低的临床效果.

Objective To investigate the clinical efficacy of the traction plate combined with the induced membrane(Masquelet)technique in the treatment of distal radius comminuted fractures with bone defects.Method Two patients with distal radius comminuted fractures with bone defects were fixed with external fixation frames in one stage and the bone defects were filled with vancomycin bone cement to create Masquelet mem-brane.At a later stage,the external fixator was removed and bone grafting was carried out across the fracture area by applying a traction plate through the 3rd metacarpal,carpal and distal radius dorsal incisions.Results Both cases were followed up for more than 15 months.2 patients recovered the flexion and extension of the injured hand after the plate was removed and the fracture healed.The review X-ray showed good healing of the radial fracture and defect area with increased bone density shadow.DASH scores:31 and 39 at 6 months postope-ratively;24 and 27 at 9 months postoperatively;20 and 22 at 1 year and 1 month postoperatively;16 and 18 at the last follow-up after removal of the plate.The Gartland-werley score at the last follow-up visit was good in both cases.Conclusion The traction plate combined with the Masquelet technique for the treatment of distal radius comminuted fractures with bone defects has a stable and strong clinical outcome with a low risk of infection.