掌侧锁定钢板治疗伴背侧骨块的桡骨远端骨折

摘要
图/表
参考文献
相关文章 (15)

全文: PDF (1651 KB) HTML (1 KB)
输出: BibTeX | EndNote (RIS)

摘要目的本研究旨在运用三维重建技术探索掌侧锁定钢板内固定治疗伴背侧骨块的桡骨远端骨折的临床疗效。方法回顾性分析我院自2016年7月至2019年12月收治的伴有背侧骨块的桡骨远端骨折病例共78例。其中男30例，女48例；年龄25~82岁，平均（53.5±9.2）岁。通过Mimics三维重建技术重建桡骨远端关节面，将累及骨性隆起内侧部分的背侧骨块作为关节内骨块，未累及者为关节外骨块，共得到背侧关节内骨块病例58例，背侧关节外骨块病例20例。研究一：将20例伴背侧关节外骨块的桡骨远端骨折患者与同期20例不伴背侧损伤的桡骨远端骨折患者进行病例对照研究，使用SPSS 23.0 软件比较两组患者内固定术后3个月及12个月的影像学指标（掌倾角、尺偏角、桡骨高度）、腕关节活动度（背伸、掌屈、旋前、旋后）、握力、上肢功能评分(disability of arm shoulder hand，DASH)，腕痛视觉模拟评分(visual analogue scale，VAS)。研究二：将伴背侧关节内骨块病例按照背侧骨块术后移位距离是否大于2mm分为移位组（12例）及非移位组（46例）进行病例对照研究，比较指标同研究一。结果所有手术均顺利完成，无一例并发症发生。研究一：所有患者均获随访，随访时间12~24个月，平均（14.5±3.3）个月。两组患者术后影像学指标（掌倾角、尺偏角、桡骨高度）及腕关节活动度（背伸、掌屈、旋前、旋后）、握力、DASH评分、VAS评分差异无统计学意义（P＞0.05）。研究二：所有患者均获随访，随访时间12~24个月，平均（15.7±3.8）个月。未移位组患者术后3个月及12个月腕关节背伸活动度、DASH评分及VAS评分均优于移位组，未移位组患者术后3个月握力及术后12个月腕关节掌屈活动度优于移位组，差异有统计学意义（P＜0.05），其余指标差异无统计学意义。移位组AO C3型骨折多于未移位组，差异具有统计学意义（P＜0.05）。结论 Mimics三维重建技术可有效区分桡骨远端背侧关节内及关节外骨块，有助于术前计划的制定。掌侧内固定治疗伴背侧关节外骨块的桡骨远端骨折可获得良好的临床疗效。伴背侧关节内骨块的桡骨远端AO C3型骨折掌侧内固定术后内固定失效风险较高，将造成腕关节疼痛，腕关节屈伸活动度、握力以及腕关节功能下降。

	服务

	把本文推荐给朋友
	加入我的书架
	加入引用管理器
	E-mail Alert
	RSS
	作者相关文章

关键词 ：三维重建, 桡骨远端背侧骨块, 临床疗效

Abstract：

Objective To explore the clinical efficacy of volar locking plate for internal fixation for distal radius fractures with dorsal fragment based on 3D reconstruction technology.Methods A retrospective analysis was performed on the 78 patients of distal radius fracture with dorsal fragment in Tongji Hospital Affiliated to Tongji University from July 2016 to December 2019，including 30 males and 48 females.The average age of patients was(53.5±9.2)years.The Mimics 3D reconstruction technology was used to reconstruct the distal radius articular surface，and the dorsal fragments were divided into two groups according to involvement of articular surface，including 20 patients with dorsal intra-articular fragment and 58 patients with dorsal intra-articular fragment.In the firstresearch，20 patients of distal radius fracture with dorsal extra-articular fragment were compared with 20 patients of distal radius fracture without dorsal injury.The radiographic data (radial inclination，volar angulation，radius height)，range of wrist motion (volar flexion，dorsal flexion，forearm supination，forearm pronation)，grip strength，disability of arm shoulder hand (DASH) score，and wrist visual analogue scale (VAS) score were compared at 3 and 12 months after operation by SPSS 23.0 statistics software.In the second research 58 patients with dorsal intraarticular fragment were divided into displaced group (12 cases) and undisplaced group (46 cases ) according to the presence of dorsal fragment displacement (＞2mm) after volar fixation.Same indexes were compared between groups.Results All operations were completed successfully without complication.In the first research，all patient were followed up with a mean follow-up time of (14.5±3.3)months.There was no significant difference in radiographic data (radial inclination，volar angulation，radius height)，range of wrist motion (volar flexion，dorsal flexion，forearm supination，forearm pronation)，grip strength，DASH score and wrist VAS score between groups (P＞0.05).In the second research，all patients were followed up with a mean follow-up time of (15.7±3.8)months.There was more AO C3 type distal radius fractures in the displaced group than undisplaced group.The range of dorsal flexion，DASH score and VAS score of the undisplaced group were significantly better than displaced group at 3 months and 12 months after the operation(P＜0.05).The range of volar flexion of undisplaced group was significantly better than displaced group at 12 months after operation(P＜0.05).Grip strength of undisplaced group were significantly better than displaced group at 3 months after operation(P＜0.05) and there was no statistical difference in other data between groups.Conclusion Mimics 3D reconstruction technology can effectively distinguish the dorsal intra-articular and extra-articular fragment of distal radius，help the formulation of preoperative plans.Volar internal fixation for the treatment of distal radius fracture with dorsal extra-articular fragment can achieve good clinical outcome.AO C3 type distal radius fractures with dorsal intra-articular fragment after volar fixation have high risk of internal fixation failure which would cause wrist pain，and lower the range of wrist motion，grip strength and wrist function.

Key words： 3D reconstruction dorsal fragment of distal radius clinical outcome

基金资助:上海市重中之重临床医学中心及重点学科建设计划(2017ZZ02004)

通讯作者: 袁锋

作者简介: 季佳庆(1994－ )，男，医师，同济大学附属同济医院，200065。

引用本文:

季佳庆 1，2,樊健 1，2,王健 1，2,张鑫 1，2,袁锋 1，2*. 掌侧锁定钢板治疗伴背侧骨块的桡骨远端骨折[J]. 实用骨科杂志, 2021, 27(8): 678-683.
Ji Jiaqing 1，2，Fan Jian 1，2，Wang Jian 1，2，et al. Clinical Effect of Volar Locking Plate in the Treatment of Distal Radius Fractures with Dorsal Fragment. sygkzz, 2021, 27(8): 678-683.

链接本文:

http://www.sygkzz.com/CN/ 或 http://www.sygkzz.com/CN/Y2021/V27/I8/678

［1］Bentohami A，Bosma J，Akkersdijk GJM，et al.Incidence and characteristics of distal radial fractures in an urban population in the Netherlands［J］.Eur J Trauma Emerg Surg，2014，40(3)：357-361.
［2］Mellstrand-NavarroC，PetterssonHJ，TornqvistH，et al.The operative treatment of fractures of the distal radius is increasing：results from a nationwide swedish study［J］.Bone Joint，2014，96B(7)：963-969.
［3］Ikeda K，Osamura N，Tada K.Fixation of an ulnodorsal fragment when treating an intraarticular fracture in the distal radius［J］.Hand Surg，2014，19(1)：139-144.
［4］Lee JI，Cho JH，Lee SJ.The effects of the Frag-Loc compression screw on distal radius fracture with a displaced dorsoulnar fragment［J］.Arch Orthop Trauma Surg，2015，135(9)：1315-1321.
［5］Kim JK，Cho SW.The effects of a displaced dorsal rim fracture on outcomes after volar plate fixation of a distal radius fracture［J］.Injury，2012，43(2)：143-146.
［6］Kim JK，Yun YH，Kim DJ.The effect of displaced dorsal rim fragment in a distal radius fracture［J］.J Wrist Surg，2016，5(1)：31-35.
［7］Tanabe K，Nakajima T，Sogo E，et al.Intraarticular fractures of the distal radius evaluated by computed tomography［J］.J Hand Surg，2011，36(11)：1798-1803.
［8］Johnson JE，Troy KL.Validation of a new multiscale finite element analysis approach at the distal radius［J］.Med Eng Phys，2017(44)：16-24.
［9］王郑浩，李开南，汪学军，等.基于三维CT的关节内桡骨远端骨折地图研究［J］.中华骨科杂志，2019，39(22)：1373-1380.
［10］Teunis T，Bosma NH，Lubberts B，et al.Melone's concept revisited：3D quantification of fragment displacement［J］.J Hand Microsurg，2016，8(1)：27-33.
［11］Anderson DD，Deshpande BR，Daniel TE，et al.A three-dimensional finite element model of the radiocarpal joint：distal radius fracture stepoff and stress transfer［J］.Iowa Orthop J，2005(25)：108-117.
［12］Anderson DD，Bell AL，Gaffney MB，et al.Contact stress distributions in malreduced intraarticular distal radius fractures［J］.J Orthop Trauma，1996，10(5)：331-337.
［13］Knirk JL，Jupiter JB.Intraarticular fractures of the distal end of the radius in young adults［J］.J Bone Joint Surg (Am)，1987，69(5)：791.
［14］Miyashima Y，KaneshiroY，Yano K，et al.Size and stabilization of the dorsoulnar fragment in AO C3type distal radius fractures［J］.Injury，2019，50(11)：2004-2008.