掌侧人路治疗背侧移位的桡骨远端关节内骨折

摘要

Objective To treat dorsally displaced intra-articular fractures of the distal radius, and to assess the integrity of radiocarpal joint and the reliability of stable fixation fracture. Methods Sixty-three cases(65 sides)patients with dorsally displaced intra-articular fractures of the distal radius were performed operatively with the open reduction and internal fixation via palmar approach between August 2003 and May 2008. The series included 20 males(21 sides)and 43 females (44 sides). The mean age of patients was 52.4 years ranging from 18 to 82 years. According to the Frykman classification, 6 sides were of type Ⅲ, 8 of type Ⅳ, 5 of type Ⅴ, 4 of type Ⅵ, 13 of type Ⅶ and 29 of type Ⅷ. With the exception of the radiocarpal arthrography and the standard antero-posterior and lateral views of the wrist joint, two new tangential anteroposterior and lateral views of the wrist joint were intraoperatively described so as to observe the relation of the distal screws with the articular surface. Results The 53 cases (54 sides) of the 63 cases (65 sides) were followed up, and the follow-up time was averagely 16.4 months ranging from 4 to 47 months. According to Gartland and Werley criteria, 32 sides were rated as excellent(59.3%), 14 sides as good(25.9%), 7 fair (13.0%)and 1 poor(1.8%),and the excellent-good rate was 85.2%. Observing the new tangential anteroposterior and lateral views of the wrist joint,it showed that screws appeared penetrating into the radiocarpal joint in 26 of the 42 sides by standard antero-posterior view and in 31 of the 42 sides by standard lateral view. Conclusion This palmar approach represents a simple and valuable treatment methodology for the most frequent types of unstable fractures of the distal radius in young and elderly patients.%目的 应用掌侧入路治疗背侧移位的桡骨远端关节内骨折,评估蘑建桡腕关节面的完整性和稳定固定骨折的可靠性.方法 2003年8月至2008年5月,经掌侧入路治疗63例(65侧)背侧移位的桡骨远端关节内骨折,男20例(21侧),女43例(44侧);年龄18～82岁,平均年龄52.4岁,以老年居多.按照Frykman分类法,Ⅲ型骨折6侧,Ⅳ型骨折8侧,Ⅴ型骨折5侧,Ⅵ型骨折4侧,Ⅶ型骨折13侧,Ⅷ型骨折29侧.术中除采用桡腕关节造影术和标准的腕关节正侧位外,应用新的切线位的腕关节正侧位观察远端螺钉与关节面的关系.结果 53例(54侧)获得随访,随访时间5～47个月,平均16.4个月.按照Gartland和Werley评分,优32侧(59.3%),良14侧(25.9%),可7侧(13.O%),差1侧(1.8%),优良率85.2%.应用新的切线位的腕关节正侧位X线片显示42侧标准的腕关节正侧位的26侧正位和31侧侧位的远端螺钉进入关节.结论 掌侧入路的方法对于大多数不同类型的桡骨远端关节内骨折是一种简单有效的治疗方法.