关节镜辅助下外固定架治疗桡骨远端严重粉碎骨折

摘要

目的 探讨关节镜辅助下外固定架克氏针固定在桡骨远端骨折治疗效果.方法 回顾2010年3月～2012年1月间我院收治的27例桡骨远端严重粉碎骨折(观察组),术中以外固定架固定,牵开关节间隙,切开复位克氏针内固定骨折,术中应用关节镜进行腕关节内观察,检测关节面对位情况,同时切断桡神经腕背支(骨间背侧神经),术后以X线评估关节面对位,并随访腕关节功能恢复情况,设同期收治常规手术复位治疗的桡骨远端严重粉碎骨折27例(对照组),对比两组患者腕关节功能恢复情况.结果 治疗组手术时间明显缩短,患者术后关节面阶梯改变优于对照组,随访5～27个月,根据Krimmer评分表评估体系,治疗组腕关节功能恢复情况优于对照组,组间比较差异显著(P＜0.05).结论 外固定架下应用关节镜辅助治疗桡骨远端关节面骨折复位可以避免关节面出现阶梯改变,最大程度恢复关节的功能,减轻创伤性关节炎.%Objective To evaluate the outcomes of arthroscopy-assisted treatment of severe comminuted distal radial fracture with external fixators and kirschner wire fixation. Methods Twenty-seven cases of severe comminuted distal radial fracture treated between March, 2010 and January, 2012 were reviewed. During the operation, the carpal joint space was expanded with the external fixator, and the fracture was fixed by Kirschner wire after open reduction. The carpal joint was observed intraoperatively with arthroscopy to ensure full reduction, and the distal posterior interosseous nerve was then severed. The results of postoperative X-ray and wrist functional status of the carpal joints were recorded. Another 27 cases of severe comminuted distal radial fracture treated by conventional surgical approach served as the control group. Results The patients were followed up for a mean of 13.2 (5-27) months. Compared with the conventional surgical approach, arthroscopy-assisted treatment resulted in a significantly shorter operative time with better appearance of the articular surface and also better wrist function assessed using the Krimmer system (P<0.05). Conclusion Arthroscopy-assisted external fixator treatment is effective for management of severe comminuted distal radial fracture and avoids the stair-like appearance of the articular surface to achieve the maximal functional recovery of the carpal joints and reduce traumatic arthritis.