掌侧锁定钢板治疗伴背侧骨块的桡骨远端骨折

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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

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