摘要：
目的 探讨前臂双极骨折脱位的诊断及临床疗效. 方法 回顾性分析2011年3月至2017年9月北京积水潭医院创伤骨科收治并获完整随访的16例前臂双极骨折脱位患者资料.男14例,女2例;年龄17～48岁,平均35.8岁.左侧7例,右侧9例;主力侧10例,非主力侧6例.近端损伤:分离性肘关节脱位4例;汇聚性肘关节脱位1例;孟氏骨折脱位9例,其中Ⅰ型2例,ⅡB型2例,ⅡC型4例,Ⅳ型1例;上尺桡关节脱位2例.远端损伤:桡骨远端骨折(关节内)合并下尺桡关节脱位7例;尺桡骨远段骨折合并下尺桡关节脱位2例;盖氏骨折(桡骨干远1/3)3例;桡骨中段、中上段骨折合并下尺桡关节脱位4例.所有骨干骨折部位及多数桡骨远端进行了切开复位内固定,另外桡骨远端骨折闭合复位石膏外固定1例,外固定支架固定1例,穿针联合外固定架1例,桡骨头骨折行内固定3例,桡骨头置换3例,未处理2例,脱位行闭合复位后不稳定或不能复位行切开修复韧带5例,肘关节行铰链式外固定架固定2例.术后根据对关节稳定性的判断选择功能锻炼开始时间.末次随访时根据Anderson前臂功能评分评价前臂总体功能. 结果 16例患者术后获平均26.0个月(6～60个月)随访.术后所有骨折内固定部位均愈合,无影响功能的畸形.所有患者均未发生感染,肘关节及上、下尺桡关节均稳定.行桡骨头置换者均位置好.肘关节平均屈伸活动度为123.2°(60°～ 140°),腕关节平均屈伸活动度为150.3°(120°～ 160°),前臂平均旋转活动度为144.4°(70°～ 170°).末次随访时根据An-derson前臂功能评分:优11例,满意3例,不满意1例,失败1例. 结论 前臂双极骨折脱位大多为高能量损伤,治疗重点是良好复位远、近端的脱位,并尽可能早的进行活动,术中固定骨折需要以较稳定的复位脱位为基础.两端脱位均得以复位并能早期活动的患者常可获得良好的功能.%Objective To investigate diagnosis and surgical treatment of bipolar fracture-dislocation of the forearm.Methods A retrospective study was conducted of 16 patients with forearm bipolar fracture-dislocation who had been treated and completely followed up at Department of Orthopaedic Trauma,Beijing Jishuitan Hospital from March 2011 to September 2017.They were 14 males and 2 females,aged from 17 to 48 years (average,35.8 years).Their injury involved 7 left and 9 right sides,and 10 dominant and 6 non-dominant sides as well.Their proximal injury was divergent elbow dislocation in 4 cases,convergent elbow dislocation in one case,Monteggia fracture-dislocation in 9 cases (2 ones of type Ⅰ,2 ones of type ⅡB,4 ones of type ⅡC and one of type Ⅳ),and upper radioulnar dislocation in 2 cases.Their distal injury was distal radial fracture (intra-articular) + lower radioulnar dislocation in 7 cases,distal radioulnar fracture + lower radioulnar dislocation in 2 cases,Galeazzi fracture (1/3 distal humeral shaft) in 3 cases,and middle and upper middle radial fracture + lower radioulnar dislocation in 4 cases.Open reduction and internal fixation was performed for all the shaft fractures and most of the distal radial fractures.One distal radius fracture was treated with closed reduction and external fixation,one case with external fixation,one case with needle insertion and external fixation,3 radial head fractures with internal fixation,3 cases with radial head replacement,2 cases untreated,5 cases with open ligament repair because their primary closed reduction failed,and 2 cases with hinged external fixation of the elbow.Their functional exercise started according to judgment of joint stability after surgery.At the last follow-up,the overall function of the forearm was evaluated according to the Anderson's scoring.Results The 16 patients were followed up for an average of 26.0 months (from 6 to 60 months).All fractures healed at the internal fixation sites after operation with no abnormality affecting the function.No infection occurred.All the elbow joints and upper and lower radioulnar joints were stable.All the radial head replacements were in good position.The range of elbow flexion and extension averaged 123.2° (from 60° to 140°),the range of wrist flexion and extension 150.3° (from 120° to 160°),and the rotational mobility of the forearm 144.4° (from 70° to 170°).At the last follow-up,according to the Anderson's scores,11 cases were rated as excellent,3 cases as satisfactory,one case as unsatisfactory and one case as failure.Conclusions Most of the forearm bipolar fractures and dislocations are high-energy injury.The key to treatment is to achieve good reduction of distal and proximal dislocations and to start rehabilitative exercise as early as possible.Intraoperative fixation of fractures should be based on stable reduction of the dislocation.Fine reduction of bipolar dislocations and early rehabilitation can lead to good functional recovery.
