DVR解剖型锁定钢板治疗陈旧性桡骨远端骨折的评价

发布时间：2018-08-31 08:40

【摘要】：[目的]评估解剖型桡骨远端掌侧锁定接骨板系统(DVR system)在陈旧性桡骨远端骨折中的应用及其治疗效果。[方法]自2012年6月至2015年2月收治陈旧性桡骨远端骨折38例,其中男27例,女11例,年龄29~68岁,平均51.21岁。所有病例术前均行三维CT重建评估骨折情况。原始骨折根据AO分型标准,A2型3例;A3型6例;B1型6例;B2型8例;B3型5例;C1型4例;C2型4例;C3型2例。所有桡骨远端骨折均寻原骨折线复位或截骨矫正畸形,其中单纯掌侧入路DVR固定31例;掌、背联合入路掌侧DVR固定7例;尺骨远端骨折钢板固定2例,克氏针固定3例;桡尺远侧关节克氏针固定3例。18例骨缺损采用自体骨移植。[结果]术后伤口均一期愈合,无伤口感染发生。术后随访18~36个月,平均27.83个月,所有骨折均在6个月内愈合,其中解剖复位30例。本组患者术后第6个月和第18个月时的PRWE平均分数分别为22.9和18.6。手术合并症主要包括:螺钉过长穿入伸肌间隔2例;骨折复位丢失2例;创伤性关节炎4例;尺骨撞击综合征1例。[结论]采用DVR系统手术治疗是矫正移位明显、畸形严重的陈旧性桡骨远端骨折的有效方法。
[Abstract]:[objective] to evaluate the application and therapeutic effect of anatomic distal radius palmar locking plate system (DVR system) in the treatment of old distal radius fractures. [methods] from June 2012 to February 2015, 38 cases of old distal radius fractures were treated, including 27 males and 11 females, aged 2968 years (mean 51.21 years). All patients underwent three-dimensional CT reconstruction before operation. According to AO classification criteria, there were 3 cases of type A2, 6 cases of type B 1, 6 cases of type B 2, 8 cases of type B 3, 5 cases of type C 1, 4 cases of type C 2 and 2 cases of type C 3. All distal radius fractures were treated by reduction or osteotomy, including 31 cases with DVR fixation via palmar approach, 7 cases with metacarpal and dorsal approach with DVR fixation, 2 cases with distal ulnar fracture with plate fixation, 3 cases with Kirschner's needle fixation, 3 cases with distal ulnar fracture and 3 cases with Kirschner needle fixation. Kirschner's needle fixation of distal radioulnar joint was performed in 3 cases and 18 cases of bone defect with autologous bone graft. [results] all the wounds healed at the first stage, and no wound infection occurred. Postoperative follow-up ranged from 18 to 36 months (mean 27.83 months). All fractures healed within 6 months, including 30 cases of anatomic reduction. The mean PRWE scores were 22. 9 and 18. 6 months, respectively. Surgical complications included: 2 cases with long screw perforating extensor septum, 2 cases with loss of fracture reduction, 4 cases with traumatic arthritis and 1 case with ulnar impingement syndrome. [conclusion] DVR system is an effective method to correct the old distal radius fracture with obvious displacement and severe deformity.
【作者单位】：天津医科大学;天津市天津医院骨科;
【分类号】：R687.3

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