桡骨远端骨折的手术治疗.docVIP

桡骨远端骨折的手术治疗 作者:张元凯 作者单位：山东大学齐鲁医院骨科， 山东 济南 250012 【摘要】 目的：探讨手术治疗桡骨远端骨折的疗效。方法：手术治疗桡骨远端骨折67例，采用钢板固定33例，克氏针闭合穿针14例，外固定支架12例，克氏针和外固定支架8例。术后分别采用Stewart改良的Sarmiento评分方法行影像学评估，据Fernandez评分标准进行腕关节功能评分。结果：随访时间8 12个月，平均10个月。采用Stewart改良的Sarmiento影像学评估结果，优31例，良28例，可5例，差3例，优良率88％。根据Fernandez评分标准进行腕关节功能的评分，优28例，良29例，一般7例，差3例。优良率85％。骨折愈合时间2 6个月，平均3个月，无骨折不愈合。结论：对不能保守治疗的桡骨远端骨折，选择合适的手术方法，可获得较好的疗效。 【关键词】 桡骨 骨折 外科手术 ［ABSTRACT］ Objective: To evaluate the effect of surgical treatment on distal radius fractures. Methods: Sixtyseven patients with distal radius fractures were subjected to surgical treatment, including fixation with a plate in 33 patients, with a Kwire in 14 patients, with external fixation in 12 patients and with external fixation combined with a Kwire in 8 patients. The final anatomical results were scored based on Sarmiento′s criteria, and the functional results were valuated based on the criteria of Fernandez. Results: All the cases were followed up for an average of 10 months (8 to 12 months). Based on Sarmiento′s criteria, the results were excellent in 31 cases， good in 28 cases，fair in 5 cases， and poor in 3 cases． The goodexcellent rate was 88%. Based on Fernandez criteria， the results were excellent in 28 cases， good in 29 cases， fair in 7 cases， and poor in 3 cases． The goodexcellent rate was 85%. All the fractures healed in 2 to 6 months (averaging 3 months). Conclusion: A suitable surgical method for the unexpectant treatment patients is effective. ［KEY WORDS ］ Distal radius, fractures; Surgical procedures, operative 桡骨远端骨折是腕部常见的骨折，以往以闭合复位和外固定为主，由于骨折复位不良、固定不牢固及不能早期功能锻炼等原因，使得一些患者保守治疗效果欠佳。特别是累及关节面的粉碎性骨折,由于关节面不平整,尤其桡骨短缩,腕关节应力改变,导致腕关节功能严重损害。随着内固定理论和内固定材料的深入研究,桡骨远端骨折切开复位内固定在临床的应用越来越广泛,对于桡骨远端骨折患者功能的康复具有积极的意义。山东大学齐鲁医院骨科从2000年1月 2004年12月手术治疗桡骨远端骨折67例，取得了较好的疗效，报道如下。 1 资料与方法 1．1 一般资料 患者67例，男28例，女39例。年龄12 78岁，平均年龄45岁。闭合性骨折48例，开放性损伤19例。致伤原因：跌倒伤23例，车祸伤31例，刀砍伤7例，机器挤压伤6例。合并伤35例，其中合并其他部位骨折17例，血管、肌腱损伤7例，颅脑损伤6例，