掌侧锁定钢板治疗桡骨远端不稳定性骨折

目的探讨掌侧锁定钢板治疗桡骨远端不稳定性骨折的临床疗效。方法2006年5月至2008年12月,采用掌侧锁定钢板治疗40例桡骨远端不稳定性骨折患者,男18例,女22例;年龄19～72岁,平均41．5岁。结果全部获得随访,随访时间3～10个月,平均6个月。采用Jakim评分标准评价术后功能恢复情况：优35例,良3例,可2例,优良率为95％。结论掌侧锁定钢板治疗桡骨远端不稳定性骨折是一种较好的方法。     

掌侧锁定钢板治疗Buttazzoni B2型桡骨远端骨折

[目的]探讨掌侧锁定钢板治疗Buttazzoni B2型桡骨远端骨折的疗效。[方法]采用掌侧锁定钢板内固定治疗Buttazzoni B2型桡骨远端骨折患者127例(青年组28例,中年组36例,老年组63例),随访并动态测量掌倾角、尺偏角、桡骨茎突高度、尺骨变异等影像学指标的变化,以评估骨折再移位的情况。术后12个月行腕关节功能评分(DASH评分和Gartland和Werley评分)。[结果]术后第12个月随访测量的尺偏角、掌倾角、尺骨变异和桡骨茎突高度分别为(21.20±3.50)°、(4.97±7.54)°、(0.33±1.14)mm和(12.71±3.85)mm,相较于术后24 h测量的影像学指标差异无统计学意义。桡骨茎突高度:老年组患者短缩值高于中、青年组患者(P=0.044和P=0.049)。DASH评分平均12.2分,各年龄组间差异无统计学意义,Gartland和Werley评分均达到优(74例)或良(53例)。[结论]掌侧锁定钢板可以为Buttazzoni B2型桡骨远端骨折提供良好的稳定性,并获得满意的功能预后。     

掌侧斜T形锁定加压钢板治疗桡骨远端不稳定骨折

目的 探讨斜"T"形锁定加压钢板在桡骨远端不稳定骨折治疗中的应用和临床效果.方法 应用掌侧入路斜"T"形锁定钢板治疗桡骨远端不稳定骨折36例.结果 36例均获得随访,时间平均13个月(7～21个月),骨折均在3个月内愈合.根据Dienst标准评定疗效:优25例,良8例,可3例,优良率91.7%.结论 掌侧入路斜"T"形...     

掌侧锁定钢板与外固定架治疗复杂桡骨远端骨折

目的比较外固定架与掌侧锁定钢板治疗复杂桡骨远端骨折的临床效果。方法将2009年3月至2011年4月间实施手术治疗的60例桡骨远端关节内复杂骨折患者纳入研究。采用随机数字表法将病例随机分为掌侧锁定钢板固定组(Ⅰ组)和闭合复位外固定架治疗组(Ⅱ组),每组各30例。通过术后随访,采用相应的影像学测量参数及临床评分对手术效果进行评价。结果所有随访期内,患者的掌倾角、尺偏角、腕关节屈伸活动度及握力测试结果组间差异均无统计学意义(P>0.05)。在Cooney评分及PRWE评分方面,术后6周、3个月及6个月组间差异有统计学意义(P<0.05),Ⅰ组较Ⅱ组效果更佳,术前及术后12个月组间差异无统计学意义(P>0.05)。在总体并发症发生率方面,组间差异无统计学意义(χ2=2.588,P=0.108)。结论相比闭合复位外固定架治疗,掌侧锁定板固定在术后早期效果更佳,随着时间的推移,两种手术方式的临床评估结果趋于一致。     

桡骨远端掌侧锁定钢板内固定治疗桡骨远端骨折

目的探讨桡骨远端掌侧锁定钢板内固定治疗桡骨远端骨折的可行性。方法采用桡骨远端锁定钢板内固定治疗桡骨远端骨折32例。结果本组获随访5~12个月,全部骨折达到临床愈合,平均愈合时间7周,切口表浅感染2例,均换药治愈,未出现有切口深部感染和骨筋膜室综合征等早期并发症。StewartⅠ型评分:优28例,良3例,一般1例(解剖复位)。根据StewartⅡ评分:优25例,良4例,中2例,差1例。结论采用桡骨远端掌侧锁定钢板治疗桡骨远端骨折疗效可靠,值得推广应用。     

掌侧锁定钢板治疗桡骨远端骨折

正2014年12月~2016年1月,我科采用掌侧锁定钢板内固定治疗36例桡骨远端骨折患者,取得较好疗效,报道如下。1材料与方法1.1病例资料本组36例,男13例,女23例,年龄25~72岁。骨折按AO分型:C型8例,B型9例,A型19例。左侧13例,右侧23例。伤后至手术时间3~7 d。     

掌侧入路T形锁定钢板治疗伴有腕关节不稳定的桡骨远端骨折

笔者自2004年6月-2008年2月,收治腕关节不稳定的桡骨远端骨折22例,均采用掌侧人路T形锁定钢板固定治疗,疗效显著.     

掌侧锁定钢板联合背侧植骨治疗C3型桡骨远端骨折的疗效观察

目的 观察掌侧锁定钢板联合背侧植骨治疗C3型桡骨远端骨折的疗效。方法 回顾性分析我院2016年1月至2017年12月收治的采用掌侧锁定钢板内固定联合背侧入路植骨的19例桡骨远端AO C3型骨折病人,术后测量桡骨远端掌倾角、尺偏角及桡骨高度,采用Gartland和Werley评分系统评估腕关节功能。结果 所有病人均获得1年以上随访,Gartland和Werley腕关节功能评分显示：优10例,良7例,可2例。末次随访掌倾角为9.48°±1.84°、尺偏角为14.68°±0.82°及桡骨远端高度为（12.45±0.32） mm,与术前比较,差异均有统计学意义（P均＜0.05）。未出现伤口感染、肌腱激惹、肌腱断裂及创伤性关节炎等并发症。结论 掌侧锁定钢板联合背侧植骨治疗桡骨远端AO C3型骨折简单、可靠且有效。     

DVRTM解剖型桡骨远端掌侧锁定接骨板治疗桡骨远端骨折

本院自2011-02—2013—02采用DVRTM解剖型桡骨远端掌侧锁定接骨板内固定治疗桡骨远端骨折23例,临床疗效满意,报道如下。 1资料与方法 1．1一般资料 本组23例,男10例,女13例;年龄20-82岁,平均52岁。左侧8例,右侧15例。致伤原因：跌伤12例,车祸伤6例,坠落伤5例。闭合性骨折21例,Ⅰ度开放性骨折2例。骨折按AO,ASIF分型：A3型3例,B2型2例,B3型5例,C1型8例,C2型3例,C3型2例。受伤至手术时间5h～8d,平均5．6d。     

The use of a single volar locking plate for AO C3-type distal radius fractures

Background

A single volar locking plate (VLP) is now frequently used for open reduction and internal fixation (ORIF) of many types of distal radius fractures. Comminuted intra-articular distal radius fractures (AO C3-type) are typically the most challenging to surgically treat. No studies directly address the adequacy of a VLP alone for maintaining reduction of AO C-type fractures. We hypothesized that a single VLP provides an effective method for maintaining reduction for these fractures.

Methods

We retrospectively evaluated radiographs of a series of AO C-type fractures. Seventy-seven patients with 77 AO C3-type fractures were identified from billing records and were eligible for the study. All patients were treated by fellowship-trained hand surgeons. Radiographs at the time of union were compared to those from immediately postoperatively.

Results

Sixty-nine of 77 (89.6 %) fractures treated with VLP fixation alone for AO C3-type distal radius fractures united without loss of reduction. Eight of 77 (10.4 %) patients treated with VLP for AO C3 fractures lost reduction. The most common fracture fragment to lose reduction was the lunate fossa (5 of 8); loss of reduction of the scaphoid fossa die-punch fragment (2 of 8) and the radial styloid (1 of 8) were also seen.

Conclusions

The majority (89.6 %) of AO C3-type fractures treated with a single volar locking plate come to union without loss of reduction.Level of evidence: Level IV.     

A systematic review of volar locking plate removal after distal radius fracture

BackgroundIndication of volar locking plate (VLP) removal after bony healing of distal radius fracture (DRF) is controversial. Studies with various range of removal rate were reported. The purpose of this systematic review was to investigate the frequency and the reasons of hardware removal over the world. We hypothesized that more frequent VLP removal contribute to better clinical outcomes.MethodsThe authors searched all available literature in the PubMed and EMBASE databases for articles reporting on outcomes of treatment using VLP for DRF. Data collection included hardware removal rate, complication rate, clinical and radiological outcomes. We analyzed correlation between hardware removal rate with clinical and radiological outcomes.ResultsA total of 3472 articles were screened, yielding 52 studies for final review. The mean hardware removal rate was 9%, ranging from 0 to 100%. The mean removal rate in studies from France, Norway, Japan, and Belgium was as high as 19%. The mean removal rate in studies from the US was low (3%). The most frequent reasons for extraction were routine removal (22%), tendon irritation or tenosynovitis (14%), hardware problem (14%), and patient’ request (13%). Although routine removal and patient’ request were not counted as complication, correlation between removal rate with complication rate was strong (rho = 0.64, p < 0.001). Correlations between clinical and radiological outcomes were week except for volar tilt (rho = −0.42, p = 0.009).ConclusionsThere was a diversity of removal rate and reasons in the studies over the world. High frequent VLP removal did not contribute to better clinical outcomes.     

Routine use of locking shaft screws is not necessary in volar plate fixation of distal radius fractures

Hypothesis

Volar locking plate fixation is a common treatment method for distal radius fractures. Recently, implants have been designed with an option to use locking screws in the shaft portion of the plate. While there is a high incidence of low bone mineral density in patients who sustain fragility fractures of the distal radius, the need for locking shaft screws is not well defined. Our hypothesis is that the routine use of locking screws in the shaft portion of volar plates is not required to maintain reduction or to prevent hardware failure.

Methods

A retrospective review was performed in all patients over age 50 years who underwent volar plate fixation using an implant with non-locking shaft screws for a distal radius fracture during a 2-year period. Patients were permitted to perform early range of motion exercises. Radiographs were examined and measurements were obtained to assess maintenance of reduction and incidence of hardware failure. Patients were followed at least until fracture healing. Patients were excluded from analysis if locking shaft screws were utilized or if follow-up was inadequate.

Results

Forty-one patients met the inclusion criteria. The average age was 62 years (range 50–79). There were 12 men and 29 women. The implant used incorporated 3.5-mm shaft screws in 26 patients and 2.4-mm shaft screws in 15 patients. All patients healed within acceptable radiographic parameters (mean volar tilt = 4.9°, mean radial inclination = 21.7°, mean radial height = 11.6 mm). There were not any instances of hardware failure.

Discussion

Distal radius fractures frequently occur in patients with low bone mineral density. Non-locking, bicortically placed shaft screws provide adequate stability to allow for early range of motion without loss of reduction or hardware failure. The routine use of locking screws in the shaft portion of volar plates does not appear justified.     

特殊透视方法在掌侧锁定钢板治疗桡骨远端骨折中的临床应用

目的：通过术中附加透视拍摄侧斜位X线片观察桡骨远端螺钉与腕关节面关系及腕背切线位X线片观察远端螺钉是否穿出背侧皮质,从而评价掌侧锁定钢板治疗桡骨远端骨折的临床疗效。方法：自2020年1月至2021年6月,手术采用掌侧Henry入路治疗新鲜桡骨远端骨折45例,其中男20例,女25例,年龄32～75(52.4±8.1)岁。术中根据不同透视方法分为两组：对照组20例,为单纯透视拍摄标准正侧位X线片;观察组25例,在透视拍摄标准正侧位X线片基础上附加透视拍摄侧斜位X线片及腕背切线位X线片。观察两组术后6周及3、 6个月腕关节功能评分和术后并发症发生情况。结果：45例患者均获得随访,时间为6～14(10.8±1.7)个月,患者切口愈合良好,均获得骨性愈合。观察组并发症发生率低于对照组（P<0.05）。腕关节功能Gartland-Werley评分,观察组术后6周（4.58±1.31）分、3个月（2.98±0.63）分、6个月（1.95±0.65）分,均优于对照组术后6周（6.32±1.96）分、3个月（3.63±0.76）分、6个月（2.43±0.73）分,差异具有统计学意义（P<0....     

Minimally invasive plate osteosynthesis for distal radius fractures

Background:

Fractures of distal radius are common injury in all age groups. Cast treatment with or without close reduction is a viable option. However, the results are often unsatisfactory with restricted function. The open reduction and internal fixation often results in extensive soft tissue dissection and associated high rates of infect and delayed/nonunion. The distractor/external fixator have reported good functional and anatomical results but the incidence of pin traction infection nerve injury and cosmedic deformity are high. We introduced a modified operative technique for minimally invasive plate osteosynthesis (MIPO) for distal radial fracture and evaluated the functional outcomes and complications.

Materials and Methods:

22 distal radial fractures (10 left, 12 right) were treated using the MIPO technique and two small incisions with a palmar locking plate from August 2009 to August 2010. The wrist function was assessed according to Dienst wrist rating system, and postoperative complications were recorded.

Results:

According to Dienst wrist rating system, 13 patients showed excellent results, 6 cases showed good results and 3 patients had moderate results. No patient had poor results. Thus, the excellent and good rate was 86.4%. One patient had anesthesia in the thenar eminence and this symptom disappeared after 3 months. One patient had delayed healing in the proximal wrist crease. Two patients had mild pain on the ulnar side of the wrist and two patients had limited wrist joint function.

Conclusion:

The MIPO technique by using two small palmar incisions is safe and effective for treatment of distal radial fractures.     

单纯锁定钢板与钢板联合外固定架治疗桡骨远端复杂关节内骨折的疗效比较

目的比较单纯锁定钢板内固定和钢板内固定联合外固定架治疗桡骨远端复杂关节内骨折的临床疗效。方法回顾性分析自2010-01—2013-08行手术治疗的38例桡骨远端复杂关节内骨折。单纯采用锁定钢板内固定23例(单纯组),采用锁定钢板内固定联合外固定架治疗15例(联合组)。比较2组手术相关指标、影像学指标、腕关节功能评分。结果单纯组切口总长度短于联合组,联合组桡骨高度、掌倾角恢复程度优于单纯组,差异有统计学意义(P0.05);2组手术时间、术后当天VAS评分、尺倾角、关节面台阶差异无统计学意义(P0.05)。术后1年Mayo腕关节功能评分中,联合组总分、活动度、握力、功能高于单纯组,差异有统计学意义(P0.05);但2组疼痛评分差异无统计学意义(P0.05)。单纯组发生关节炎4例,联合组发生关节炎3例,2组关节炎发生率比较差异无统计学意义(χ2=0.041,P0.05)。结论上述2种方法治疗桡骨远端复杂关节内骨折均能有效复位,恢复关节功能。钢板内固定联合外固定架固定复位效果更好,术后1年腕关节功能更优,但有钉道感染风险。     

Outcome of dorsally comminuted versus intact distal radial fracture fixed with volar locking plates

Objective

Distal radial fractures are common. Modern trends favour operative treatment in many instances, providing stable fixation and early functional recovery. Recent biomechanical evidence suggests that volar locking plates (VLPs) enable adequate stability for dorsally displaced fractures, both in dorsally intact (DI) and in dorsally comminuted (DC) fractures. The aim of the study was to compare the clinical outcome of these two fracture groups treated with a VLP.

Methods

Retrospective case-control analysis of 91 distal radial fractures treated surgically using VLP by a single surgeon between the years 2006 and 2008 was carried out. Fractures were classified according to the Arbeitsgemeinschaft für Osteosynthes/Orthopaedic Trauma Association (AO/OTA) classification. Based on initial pre-reduction X-rays and computed tomography (CT) scans, fractures were classified into two groups of DI and DC fractures. The patients were re-evaluated at 2 and 6 weeks, 3 and 6 months and 1 year.

Results

Forty-one fractures (45%) were dorsally comminuted. Patients in the DC group were significantly older (mean 59 vs. 46 years, p < 0.01) and included more female patients, as well as significantly more C3 type fractures than the DI group (p < 0.04). The mean Disabilities of the Arm, Shoulder and Hand (DASH) score at 1 year postoperatively was 6.3 ± 2.3 for the DC group, as compared with 6.6 ± 2.02 for the DI group (p = 0.64). Average time to return to work was longer in the DC group (81.2 vs. 63.6 days, p = 0.05). Range of motion, volar tilt, and radial inclination were within clinically acceptable values and did not differ significantly among the two groups.

Conclusions

VLP fixation of DC distal radial fractures results in the maintenance of reduction and comparable functional and radiographical outcome with respect to DI fractures.     

掌侧锁定接骨板与外固定架固定治疗不稳定桡骨远端关节内骨折的疗效比较

目的 比较掌侧锁定接骨板与外固定架固定治疗不稳定桡骨远端关节内骨折的临床疗效.方法 回顾性分析自2015-01-2018-03诊治的78例不稳定桡骨远端关节内骨折,47例采用掌侧锁定接骨板固定手术治疗(锁定板组),31例采用外固定架手术治疗(外固定组).比较2组手术时间、并发症情况,以及末次随访时关节塌陷情况、DASH...