外固定架结合掌侧钢板治疗桡骨远端粉碎性骨折

2006年5月~2010年2月,我院采用掌侧T形钢板结合外固定架治疗桡骨远端粉碎性骨折32例,取得较好效果。1材料与方法     

桡骨远端骨折掌侧与背侧接骨板固定的生物力学比较

目的 比较背侧移位桡骨远端骨折掌、背侧接骨板内固定后的生物力学性能,为桡骨远端骨折的治疗策略提供实验依据.方法 取6对12块人体桡骨远端标本,制作背侧移位桡骨远端骨折模型,配对标本一侧采用接骨板掌侧内固定,另一侧采用接骨板背侧内固定,固定完成后置于材料测试机上进行轴向压缩实验,实验模式为载荷破坏实验,记录载荷一位移曲线,获得标本破坏时的载荷和骨吸收的能量,实验结果进行统计学配对处理.结果 5对标本在轴向载荷下向掌侧发生成角倾斜,1对标本在轴向载荷下发生骨折端的嵌插.掌侧接骨板固定组的平均破坏载荷为[(1 520.05±579.56)N,x±s,下同],破坏时骨吸收的能量平均为(10.04 ±3.62)J;背侧接骨板固定组的平均破坏载荷为(1 326.77±384.86)N,标本破坏时骨吸收的能量平均为(8.21±3.74)J,组间对比差异无统计学意义(P>0.05).结论 掌侧接骨板固定是治疗桡骨远端骨折理想的固定方式.     

外固定支架治疗桡骨远端粉碎性骨折

2003年3月～2009年10月,我科采用上肢多功能外固定器治疗桡骨远端粉碎性不稳定骨折38例,疗效满意. 1 材料与方法 1.1 病例资料本组38例,男17例,女21例,年龄20～65(37.3±10.2)岁.均为粉碎性骨折,其中Colles骨折10例,Smith骨折8例,Barton骨折20例(见图1A).1例为开放性伴肌腱、血管、神经损伤骨折,余为新鲜闭合骨折.有8例骨折门诊手法复位后石膏托固定,复查X线示骨折再移位而改用外固定器固定手术.     

掌侧锁定加压钢板治疗桡骨远端粉碎性骨折的临床分析

目的 探讨锁定加压钢板治疗桡骨远端粉碎性骨折的临床疗效.方法 回顾性分析2005年2月～2010年12月应用锁定加压钢板治疗桡骨远端粉碎性骨折55例的临床资料.按AO/ASIF分型:C1型28例,C2型17例,C3型10例.均为闭合性新鲜骨折.结果 所有患者术后获得8～15个月,平均12个月的随诊.均骨性愈合,平均愈合时间9周.按Gartland/werley腕关节评分:优32例,良10例,可12例,差1例;优良率为76.4％.结论 应用锁定加压钢板治疗桡骨远端粉碎性骨折有利于骨折复位,为维持桡骨高度、掌倾角、尺偏角提供持续、坚强的固定,具有良好的临床疗效.     

应用外固定支架治疗桡骨远端粉碎性骨折

目的 探讨桡骨远端粉碎性骨折治疗方法及临床疗效.方法 应用外固定支架治疗桡骨远端粉碎性骨折26例.结果 26例全部获得随访,时间2～14个月.按Denist功能评估标准评定疗效:优18例,良6例,可2例.结论 应用外固定支架治疗桡骨远端粉碎性骨折,能最大限度地恢复桡骨与尺骨的相对长度,矫正掌倾角及尺偏角,术后配合合理的康复锻炼,能最大限度地恢复腕关节功能.     

超关节外固定架治疗桡骨远端粉碎性骨折

我院自2000年以来采用超关节单臂外固定架治疗桡骨远端粉碎性骨折36例，术后骨折对位对线佳，愈合快，腕关节功能恢复好，取得了良好的疗效。     

翼状解剖钢板治疗股骨远端粉碎性骨折的生物力学研究

目的分析为股骨远端骨折专门设计的翼状解剖钢板生物力学的可靠性,探讨治疗股骨远端粉碎骨折的新方法。方法取10具新鲜成人股骨标本,按统一标准(AO/ASIF系统中33C3.3型骨折)用锯将股骨远端制成干骺端-关节严重粉碎骨折模型。随机选取5具用外侧支持钢板固定作为对照,另外5具用翼状解剖钢板固定,对试件上机分别进行压缩、旋转、三点弯曲的生物力学测试。结果翼状解剖钢板组生物力学性能明显比外侧支持钢板稳定(P<0.01)。结论翼状解剖钢板固定股骨远端粉碎性骨折的稳定性高,有利于早期功能锻炼,并能防止晚期并发症的发生。     

掌侧支撑钛钢板固定治疗桡骨远端粉碎性骨折

目的探讨应用掌侧支撑钛钢板固定治疗桡骨远端粉碎性骨折的临床疗效。方法2001年1月～2004年12月对36例桡骨远端粉碎性骨折采用掌侧入路切开复位、国产T形支撑钛钢板内固定治疗。结果36例患者均获5～28个月(平均11.5个月)随访。骨折全部愈合。根据Aro等关于Colles骨折复位后的功能评价:优19例,良11例,可4例,差2例,优良率为83.3%。结论采用切开复位、掌侧T形支撑钛钢板内固定治疗桡骨远端粉碎性骨折,能最大限度地达到骨折的解剖复位,恢复腕关节功能。     

有限内固定加外固定支架治疗桡骨远端粉碎性骨折

目的探讨有限内固定加外固定支架治疗桡骨远端粉碎性骨折的临床疗效。方法采用有限内固定加外固定支架治疗桡骨远端粉碎性骨折45例。结果 42例患者获得随访,时间3～36个月。按Lidstrom评分系统行影像学评价:优30例,良7例,中5例,优良率为88.09%;依据Dienst标准评价腕关节功能:优30例,良8例,中4例,优良率为90.47%。无严重并发症发生。结论有限内固定结合外固定支架治疗桡骨远端粉碎性骨折,复位满意,操作简单,固定牢固,疗效满意。     

锁定加压钢板治疗桡骨远端粉碎性骨折

2004年7月～2011年6月,我科应用锁定加压钢板(LCP)治疗27例桡骨远端粉碎性骨折患者,疗效满意。1材料与方法1.1病例资料本组27例(29侧)男12例,女15例,年龄20～75岁。右侧16例,左侧9例,双侧2例。手术时间为伤     

经皮穿针结合外固定架治疗桡骨远端粉碎骨折

桡骨远端骨折为临床常见病,约占急诊骨折患者的1／6。多系跌倒后手部撑地所致,成年人桡骨远端骨折多为粉碎性,常伴有明显嵌插短缩、侧移及向掌（或背侧）成角畸形,并且较多的病例为累及桡骨远端关节面的骨折。采用传统手法复位结合小夹板或石膏固定常难以达到良好的治疗效果,后期腕部遗留的严重畸形常需行矫形手术治疗。自2005年1月至2007年7月,我院采用手法复位经皮穿针内固定结合外固定架固定治疗桡骨远端粉碎骨折35例,取得良好疗效果,现报告如下。     

桡骨远端粉碎性骨折的手术治疗

1999年1月~2005年1月,我院采用手术治疗桡骨远端粉碎性骨折32例,取得满意疗效。1材料与方法1.1病例资料本组32例,男21例,女11例,年龄11~68岁。开放性骨折5例,闭合性骨折27例。按AO分类:B1型4例,B2型11例,C1型8例,C2型8例,C3型1例。1.2治疗方法分为3组:①切开复位克氏针内固定组     

桡骨远端粉碎骨折并关节面翻转的诊治体会

目的 探讨桡骨远端粉碎性骨折合并关节面翻转的诊断与治疗方法.方法 对4例(5侧)桡骨远端粉碎性骨折合并关节面翻转的患者,用CT断层扫描和三维重建技术进行诊断,采用外固定支架或结合有限内固定进行治疗.结果 术前3例获得确诊,1例(双侧)漏诊.术后4例获得6～30个月的随访,平均12个月.术前腕关节尺偏角为-10°～15°(平均12.5°),掌倾角为-25°～0°(平均-10°);术后尺偏角为20°～30°(平均25°),掌倾角为0°～20°(平均11.0°).按Dienst功能评估标准评定:优4侧,良1侧.术后无针道感染、针孔骨折、神经血管损伤、伤口感染及骨髓炎等并发症.结论 外固定支架结合有限内固定是治疗桡骨远端粉碎性骨折合并关节面翻转的有效治疗方法,其操作简单、固定可靠、并发症少、疗效满意.CT扫描和三维重建技术对诊断有一定的帮助.     

Volar versus dorsal fixed-angle fixation of dorsally unstable extra-articular distal radius fractures: a biomechanic study

PURPOSE: To evaluate and compare the biomechanic rigidity and strength of 3 fixed-angle plates used to treat extra-articular distal radius fractures that are dorsally unstable. Volar fixed-angle plates were compared with a dorsal fixed-angle nail plate. METHODS: Three plate constructs were tested: the dorsal nail plate (DNP), distal volar radius (DVR) plate, and locking compression plate (LCP) volar distal radius plate. With anatomic, third-generation, artificial composite radii, dorsally unstable extra-articular distal radius fracture models were made by cutting a wedge osteotomy with an 8-mm dorsal gap 1 cm from the articular surface. These models were then fixed with the 3 implants by the method recommended by the manufacturer. The proximal radii of each specimen were attached to the base of a materials testing machine with a probe centered at the radial side of the lunate fossa. The specimens were loaded at a constant rate to failure under axial compression. Load and displacement were plotted graphically, and the resulting rigidities and strengths of each plate were assessed statistically. RESULTS: The DVR group had significantly greater stiffness than the LCP group. The DVR group had significantly higher maximum loads than both the DNP and LCP groups. There were no significant differences in yield loads. Both the DNP and DVR groups had significantly less displacement at yield than the LCP group. CONCLUSIONS: These 3 groups had similar yield loads. However, the LCP was less stiff than the DVR and had more displacement at yield than both the DVR and DNP. The yield load of all 3 implants was much higher than previously described loads for active wrist and finger motion.     

Volar fixation for dorsally angulated extra-articular fractures of the distal radius: a biomechanical study

PURPOSE: To compare the biomechanical properties of 10 volar plate-fixation designs in 2 fracture models (dorsal wedge osteotomy, segmental resection osteotomy models). METHODS: Forty-eight radiuses were used in this study including 8 pairs. In 40 specimens a 15-mm dorsally based wedge osteotomy was performed and the volar cortex was fractured manually. They were arranged into 10 fixation groups with 5 different fixation designs (test 1). In the contralateral specimens of 8 paired radiuses a 10-mm segment of bone was excised (test 2). Four of the 10 fixation systems were chosen for these specimens. Cadaver hands and the proximal radiuses were potted in polymethylmethacrylate and tested with a servohydraulic materials testing machine with 300 N of axial compression load at 1 N/s initially and after each 1,000 cycles up to 5,000 cycles. After cyclic loading the specimens were loaded to failure in axial compression at 2 mm/min. The stiffness, failure peak load, and failure mode of each specimen were recorded. RESULTS: In test 1 in the wedge osteotomy specimens the T plate was the stiffest and the Synthes titanium plate was the least stiff; however, all specimens completed the 5,000 cycles of loading with no failures. There was no significant difference between the 10 fixation groups in failure peak load and only 7 of 40 failed at the distal portion of the hardware in the final load to failure testing. In test 2 the resection osteotomy specimens were less stiff and failed at a lower failure peak load compared with the wedge osteotomy specimens. Failure at the distal portion of the fixation system was seen in 7 of 8 specimens; nonlocking screws loosened and tines compressed the surrounding bone, resulting in tine-hole enlargement. CONCLUSIONS: All of the plate-fixation systems delivered sufficient stability to permit the simulated postoperative regimen of 1 week of immobilization followed by 5 weeks of early mobilization until expected union at 6 weeks after surgery. Based on these results a preferable volar fixation system would appear to benefit from the following: (1) sufficient plate strength to support the distal fragment from the volar side, (2) a locking system with sufficient strength to remain locked during the healing process, and (3) a distal design that does not affect the bone adversely. The anatomic reduction of the volar cortex in the wedge osteotomy specimens added stability to the construct.     

桡骨远端粉碎性骨折的治疗

1995年10月~2003年9月,笔者共收治51例波及关节面的桡骨远端粉碎性骨折患者,经切开复位内固定或以传统手法复位加腕关节旋转法复位及石膏或小夹板外固定,均获得满意疗效。1材料与方法1.1病例资料本组51例,男22例,女29例,年龄29~76岁。左侧20例,右侧31例。按AO分型均为C3型。桡骨远端粉碎性完全关节内骨折并发尺骨茎突骨折19例,下尺桡关节分离8例。1.2治疗方法随机分两组。手术组:10例,行切开复位,钢板、骨片钉或克氏针内固定,术后石膏托功能位外固定3周;手法复位组:41例,手法复位时利用腕关节面的模具作用使关节面平整塑型[1],然后行腕关…     

垂直钢板与平行钢板固定治疗肱骨髁间粉碎性骨折的生物力学比较研究

目的 从生物力学方面比较平行钢板与垂直钢板固定治疗肱骨髁间粉碎性骨折的优缺点,为临床治疗方法的选择提供理论基础. 方法 取3具成人上肢尸体标本(6个),用骨刀将肱骨远端制成T型骨折模型.将同一具尸体的左、右两侧肱骨标本分别行垂直钢板与平行钢板固定.将固定好的标本以5 N/s的速率进行纵向垂直加载,最大加载负荷为2000N,共3次,取其平均值,记录肱骨被压缩时的垂直压缩位移、髁间分离的开口位移、内外髁内部的形变及垂直压缩刚度. 结果 在相同载荷下,应用平行钢板固定的压缩位移、开口位移及内外髁形变均小于垂直钢板固定,差异有统计学意义(P＜0.05),采用平行钢板固定的轴向压缩刚度大于垂直钢板固定,差异有统计学意义(P＜0.05). 结论 平行钢板固定治疗肱骨髁间粉碎性骨折的生物力学性能优于垂直钢板固定.