桡骨远端不稳定骨折掌侧或背侧内固定的选择

Selection of dorsal or volar internal fixation for unstable distal radius fractures

目的 探讨T型钢板在治疗桡骨远端不稳定骨折中的应用及对治疗效果的影响。方法 根据桡骨远端不稳定骨折的特点 ,就不同类型骨折分别采用T型钢板掌侧或背侧固定 ,对于骨皮质破坏较严重 ,支撑不满意的病例 ,通过植入人工骨或自体骨来恢复局部的稳定性。 结果 本组 6 4例病例 ,经手术复位 ,纠正畸形满意 ,术后 2～ 3d开始指导下的功能训练。平均随访时间 2 9 6 3个月 ,总体优良率达 90 77%。其中 ,5 5侧行掌侧固定 (其中 30侧为桡骨远端骨折向背侧移位 ) ,优良率达 92 72 % ;伤后 6周以上陈旧骨折或损伤情况估计从掌侧入路有困难的患者 ,采用背侧入路钢板固定 ,优良率为 77 77%。 结论 桡骨远端骨折向掌侧移位的病例 ,掌侧入路是理想的方式 ,对于向背侧移位的病例 (Colles骨折 ) ,同样也具有良好的手术效果。桡骨远端掌侧切口治疗桡骨远端不稳定骨折具有 :骨床平坦 ,易操作 ,符合张力带原则 ,软组织破坏相对较少 ,维持背侧软组织合页的完整性 ,植骨不易外漏等优点。掌侧入路钢板固定对于桡骨远端不稳定骨折的治疗效果是满意的 ,特别是对新鲜骨折 ;陈旧骨折在 6周以内有条件仍可从掌侧入路 ,并疗效满意。背侧入路钢板固定 ,治疗效果稍差 ,背侧截骨后植骨的患者 ,对功能恢复有一定影响。

ObjectiveTo assess the results of T-plate in the treatment of unstable distal radius fractures.MethodsDorsal or volar T-plate fixation was used for unstable distal radius fractures according to different types of fracture. For comminuted fractures with severe cortex destruction and insufficient buttress, artificial bone graft or autograft was adopted to restore local stability.ResultsSatisfactory reduction was achieved after surgery. Functional rehabilitation under surveillance began from the 2nd or 3rd post-operative day. The overall excellent or good recovery rate was 90.77% after a mean follow-up of 29.63 months. For the 55 sides of volar fixation(30 sides with a dorsal displacement fragment), excellent or good recovery rate was 92.72%. Dorsal fixation was used in delayed cases(>6 weeks) or certain fracture patterns unsuitable for volar approach. The excellent on good recorery rate was 77.77%.Conclusions Volar approach is an ideal option not only for distal radius fracture with a volar displaced fragment but also for dorsal displaced fractures(Colles′ fracture). The advantages of this approach include flat cortex for easy plate fixation, better tension band effect, less soft tissue destruction, leaving dorsal soft tissue hinge intact, and avoiding bone graft leakage. Satisfactory results can be obtained in those patients with unstable distal radius fracture through volar approach plate fixation, especially in those with fresh fractures. If possible, volar approach can also be used in delayed fractures within 6 weeks. The results of dorsal fixation is a little bit in ferior.