腕关节镜辅助下切开复位掌侧锁定接骨板内固定治疗桡骨远端关节内粉碎性骨折

发布时间：2019-03-28 20:06

【摘要】：目的:探讨关节镜辅助下切开复位掌侧锁定接骨板内固定治疗桡骨远端关节内粉碎性骨折的临床效果。方法:2014年9月-2016年10月,收治15例桡骨远端关节内粉碎性骨折。其中男性10例,女性5例;年龄31~57岁,平均年龄42.6岁。术前行腕关节X线及CT检查,确定骨折按AO分型均为C2或C3型。在采用腕关节镜辅助下切开复位掌侧锁定接骨板内固定治疗此类桡骨远端骨折的同时一并处理骨折相关的软组织损伤,诸如:三角纤维软骨复合体(TFCC)、舟月韧带、月三角韧带损伤等。以最近一次随访复查的X线片测量掌倾角等放射线指标,同时复查腕关节活动度及握力等相关数据。结果:15例患者均获得随访,随访时间5-12个月,骨折愈合时间为7-11周,平均8.4周。在最近一次随访时,15例患者中7例已二次手术取出掌侧接骨板,8例患者尚未取出掌侧接骨板。7例取出掌侧接骨板的患者中,取出掌侧接骨板的时间为10-13个月,平均11.4个月。15例患者最近一次随访结果:掌倾角8°-17°,平均13°;尺偏角19°-26°,平均22.4°;腕关节屈曲运动幅度:56°-67°,平均60°;背伸运动幅度:48°-70°,平均56°;握力为健侧的65%-90%,平均81%。采用Gartland和Werley评分标准评定,优9例,良5例,可1例,优良率93.3%。15例患者中1例患者术后出现轻微的正中神经压迫症状:示中指末端感觉略麻木。待骨折愈合手术取出掌侧接骨板后症状消失。结论:腕关节镜辅助下切开复位掌侧接骨板内固定治疗桡骨远端关节内粉碎性骨折,可以在获得更好的解剖复位的同时,一并处理诸如TFCC、舟月韧带、月三角韧带损伤等软组织损伤,减少产生腕关节不稳及区域性疼痛综合征的可能。本研究表明腕关节镜辅助下切开复位掌侧接骨板内固定是治疗桡骨远端关节内粉碎性骨折可靠、有效、实用的方法。
[Abstract]:Objective: to investigate the clinical effect of arthroscopic-assisted open reduction and internal fixation of metacarpal locking plate in the treatment of comminuted intra-articular fractures of distal radius. Methods: from September 2014 to October 2016, 15 patients with comminuted fracture of distal radius were treated. There were 10 males and 5 females, 31 years old and 57 years old, with an average age of 42.6 years. X-ray and CT examination of wrist joint were performed before operation. According to AO classification, all fractures were C _ 2 or C _ 3 type. Open reduction and internal fixation of the metacarpal locking plate assisted by wrist arthroscopy for the treatment of such distal radius fractures together with fracture-related soft tissue injuries, such as the triangular fibrocartilage complex (TFCC), scapholunar ligament, Injury of trigonometric ligament of the moon and so on. The most recent follow-up X-ray films were used to measure the metacarpal inclination angle and other radiographic parameters, and the wrist motion and grip strength were also reexamined. Results: all the 15 patients were followed up for 5 months and 12 months. The fracture healing time was 7 and 11 weeks (mean 8.4 weeks). At the most recent follow-up, 7 of the 15 patients had taken out the palmar plate twice, 8 patients had not removed the palmar plate, and 7 of the 7 patients who had removed the palmar plate had been removed for 10 months and 13 months, and the time of removal of the palmar plate was 10 months and 13 months, while the palmar plate was removed in 8 of the 15 patients who had not removed the palmar plate. The results of the last follow-up of 15 patients were as follows: the palmar dip angle was 8 掳- 17 掳(mean 13 掳); The flexion amplitude of wrist joint was 56 掳- 67 掳(mean 60 掳), the dorsal extension amplitude was 48 掳- 70 掳(mean 56 掳), and the grip strength was 65%-90%, average 81% of that of the normal side. According to the standard of Gartland and Werley, the results were excellent in 9 cases, good in 5 cases, fair in 1 case, the excellent and good rate was 93.3%. One of the 15 patients had mild symptoms of compression of the median nerve after operation: a slight numbness at the end of the middle finger was shown. After the fracture healing operation, the palmar plate was removed and the symptoms disappeared. Conclusion: arthroscopy-assisted open reduction and internal fixation of metacarpal plate for comminuted fracture of distal radius can provide better anatomic reduction and treatment of scapholunar ligament such as TFCC,. Soft tissue injury, such as triangular ligament injury, reduces the possibility of wrist instability and regional pain syndrome. This study shows that open reduction and internal fixation of metacarpal plate assisted by wrist arthroscopy is a reliable, effective and practical method for the treatment of comminuted intra-articular fractures of distal radius.
【学位授予单位】：吉林大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R687.3

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