桡背侧双锁定钢板治疗桡骨远端不稳定骨折

目的 探讨桡背侧双锁定钢板治疗桡骨远端骨折的临床疗效。方法 2007年3月至2009年12月采用桡背侧双锁定钢板治疗22例桡骨远端不稳定骨折患者，男12例，女10例；平均年龄47.5岁(21 ～ 78岁)。骨折AO分型：A3型1例；B2型5例；C1型2例，C2型11例，C3型3例。其中5例术中采用自体髂骨植骨。术后评估包括影像学测量尺偏角、掌倾角及桡骨高度，关节活动范围，握力测量，肩臂手功能丧失量表( DASH)评分，以及Gartland-Werley量表评分。结果 22例患者术后获平均19个月（12～32个月）随访。所钉患者骨折均在术后6个月内（2～6个月）获愈合。影像学测量尺偏角平均为25.3°(22°～29°)，掌倾角平均为12.1 °(8°～14°)，桡骨高度平均为1.1 cm(0.8 ～ 1.3 cm)。Stewart改良评分的优良率为90.9％。关节活动范围：背伸平均为53°(30°～68°)，掌屈平均为47°(32°～65°)，尺偏平均为22°(16°～ 30°)，桡偏平均为14°(11°～ 32°)，旋前平均为76°(30°～ 90°)，旋后平均为72°(10°～ 90°)。以健侧为参考，术侧握力平均为72％ (15 kg)。DASH评分平均为11.4分（0～70分），Gartland-Werley量表评分平均为3.4分（1～16分）。结论 桡背侧双锁定钢板治疗桡骨远端不稳定骨折临床疗效较好，尤其是对于背侧皮质粉碎严重的患者，能够为骨折提供更加牢固的支撑。

Double dorsal locking plates for unstable distal radial fractures

Objective To evaluate clinical results of double dorsal locking plates used in the fixation of distal radial fractures.MethodsFrom March 2007 to December 2009, 22 patients with distal radial fractures were fixed with double dorsal anatomical locking plates. They were 12 males and 10 females, with a mean age of 47. 5 years (21 to 78 years). By AO classification, there were one case of type A3, 5 cases of type B2, 2 cases of type C1, 11 cases of type C2 and 3 cases of type C3. Iliac autograft was performed in 5 patients. Clinical results and postoperative functional recovery were assessed by range of motion, grip strength, radiographic measurements of ulnar inclination, palmar tilt and radial height, the DASH (Disabilities of the Arm, Shoulder and Hand) questionnaire and the Gartland-Werley sere.Results The mean follow-up was 19 months (12 to 32 months). All fractures united within 6 months (2 to 6 months). The mean ulnar inclination angle was 25.3° (22° to 29°), the mean palmar tilt angle was 12.1° (8° to 14°), and the mean radial height was 1.1 cm (0.8 to 1.3 cm). The mean radiographic Stewart score was excellent or fine in 90. 9％ of the patients. The mean dorsal extension was 53° (30° to 68°), the mean palmer flexion was 47° (32° to 65°), the mean ulnar inclination was 22° (16° to 30°), the mean radial inclination was 14° (11° to 32°), the mean pronation was 76° (30° to 90°) and the mean supination was 72° (10° to 90°). The mean grip strength of the operated side was 72％ (15 kg) of the normal side. The mean Q-DASH and Gartland-Werley scores were 11.4 (0 to 70) and 3.4 ( 1 to 16), respectively.Conclusions Fixation with double dorsal locking plates for unstable distal radial fractures can result in fine clinical results, especially for those with comminuted dorsal hone cortex.