掌侧锁定钢板内固定联合术中超声引导闭合复位尺背侧骨块的疗效分析

The Analysis of Efficacy of the Volar Locking Plate Internal Fixation Combined with Intraoperative Ultrasound Guidance on the Treatment of Closed Reduction of the Dorsal Ulnar Fragment

目的:探讨掌侧锁定钢板内固定联合术中超声引导闭合复位尺背侧骨块的临床疗效。方法:回顾性分析2020年9月至2021年12月采用掌侧锁定钢板内固定联合术中超声引导闭合复位尺背侧骨块治疗的41例桡骨远端粉碎性骨折患者病例资料,市记录术前、术后1 d、术后1个月、术后3个月、术后6个月及末次随访时的掌倾角、尺偏角及桡骨高度,腕关节活动度,手术并发症,采用Gartland-Werley评分标准评价临床疗效。结果:41例患者均获完整随访,随访时间为10~12个月,平均为11个月。与术前相比术后各随访时间点掌倾角、尺偏角、桡骨高度及腕关节活动度均得到明显恢复,差异有统计学意义(P<0.05)。末次随访时根据Gartland-Werley腕关节评分标准:优38例,良2例,可1例,优良率为97.6%。末次随访时,X线检查无内固定物松动断裂及肌腱损伤等并发症发生。结论:采用超声引导闭合复位尺背侧骨块掌侧钢板内固定治疗桡骨粉碎性远端骨折可避免肌腱损伤,取得了良好临床效果。

Objective:To investigate the efficacy of the volar locking plate internal fixation combined with intraoperative ultrasound guidance on the treatment of closed reduction of the dorsal ulnar fragment.Methods:A retrospective analysis was conducted for 41 patients with comminuted distal radius fractures were treated with volar locking plate internal fixation combined with intraoperative ultrasound-guided closed reduction of dorsal ulnar bone block,from September 2020 to December 2021.The palmar inclination angle,ulnar deviation angle,radial height,wrist range of motion,and surgical complications were recorded before operation,1 d,1 month,3 months,6 months after operation,and at the last follow-up.The Gartland-Werley score was used to evaluate the clinical efficacy.Results:All the 41 patients were followed up completely.The follow-up time was 10-12 months,with an average of 11 months.The palmar inclination angle,ulnar deviation angle,radial height,and wrist range of motion were significantly improved at each follow-up time point compared with those before operation(P<0.05).At the last follow-up,according to Gartland-Werley wrist score criteria:the results were excellent in 38 cases,good in 2 cases,and fair in 1 case,with an excellent and good rate of 97.6%.At last follow-up,X-ray examination showed that there was no complication such as loosening of internal fixation or tendon injury.Conclusion:Ultrasound-guided closed reduction and volar plate fixation of dorsal ulnar fragment on the treatment of comminuted distal radius fractures can avoid tendon injury and achieve good clinical results.