摘要
目的:分析Ilizarov技术联合腕关节镜治疗桡骨远端不稳定骨折的临床疗效。方法:回顾性分析2019年1月至2021年12月收治的52例桡骨远端不稳定骨折患者的临床资料,其中男37例,女15例,年龄22~60岁,平均年龄(31.5±9.8)岁,左侧23例,右侧29例,骨折分型均为AO分型C型。运用环形外固定器固定前臂及掌骨,关节连接器连接,在C型臂X线机透视下通过手法复位及关节牵伸复位骨折线,并于腕关节镜下微创撬拨复位关节面,运用克氏针固定。术后4~5周去除环形外固定器,加强腕关节的屈伸、尺偏、桡偏、旋转功能锻炼,术后6~8周去除克氏针。结果:52例患者均获得随访,随访时间12~18个月,平均(15.0±2.8)个月。所有患者桡骨远端骨折均已骨性愈合,末次随访腕关节功能优49例,良3例。无针道感染、松动,无神经及血管损伤,无关节僵硬,肌肉萎缩、骨质疏松等并发症发生。结论:Ilizarov技术联合腕关节镜治疗桡骨远端不稳定骨折,不仅能达到单纯单边外固定器的固定效果,更能有效复位关节面,牵伸使关节腔的压力均衡,并减少术后过度掌屈及尺偏畸形等并发症。
Objective:To analyze the clinical efficacy of Ilizarov technique combined with wrist arthroscopy in the treatment of unstable fractures of the distal radius,and explore the value of their combined application.Methods:Totally 52 patients with unstable distal radius fractures were selected who were hospitalized from January 2019 to December 2021,including 37 males and 15 females,aged 22-60 years,with an average age of(31.5±9.8)years.There were 23 cases on the left and 29 cases on the right,all of which were classified as AO type C.Ilizarov external fixators were used to fix the forearm and metacarpal bones,with joint connectors connected.The fracture line was reduced through manual reduction and joint extension reduction under C-arm fluoroscopy.Under the monitoring of wrist arthroscopy,minimally invasive prying reduction of the articular surface and Kirschner wire fixation were used.Four to five weeks after the operation,the external fixator could be removed,and the wrist flexion and extension,ulnar deviation,radial deviation,and rotation function exercises could be strengthened.Kirschner wire removal was 6-8 weeks.Results:All patients were followed up for 12-18 months,with an average of(15.0±2.8)months.All patients had bone healing of distal radius fractures.At the last follow-up,wrist joint function score(Cooney method)was excellent in 49 cases and good in 3 cases.There was no needle infection,loosening,nerve and blood vessel damage,Joint stiffness,muscle atrophy,osteoporosis and other complications throughout the course of the disease.Conclusions:Ilizarov technique combined with wrist arthroscopy can not only achieve the effect of simple unilateral external fixator,but also effectively reposition the articular surface,while repositioning and stretching,it can equalize the pressure in the joint cavity,and reduce the complications such as excessive palmar flexion and ulnar deflection after surgery.
作者
邵文年
赵玉华
吴震
刘维平
SHAO Wennian;ZHAO Yuhua;WU Zhen;LIU Weiping(Department of Orthopaedics,Yancheng TongZhou Orthopedic Hospital,Yancheng 224007,Jiangsu;Department of Orthopaedics,Yancheng Desaibao Hospital,Yancheng 224000,Jiangsu,China)
出处
《中华骨与关节外科杂志》
CSCD
2023年第9期818-821,共4页
Chinese Journal of Bone and Joint Surgery