关节镜辅助下外固定架治疗桡骨远端严重粉碎骨折-南方医科大学学报.PDF

·1680 · 南方医科大学学报（J South Med Univ ） 2012;32(11) 临床研究 关节镜辅助下外固定架治疗桡骨远端严重粉碎骨折 李洪瀚，严康宁，钟志辉，陈金龙，郑毅全 福建医科大学附属漳州市医院骨科，福建 漳州 363000 摘要：目的探讨关节镜辅助下外固定架克氏针固定在桡骨远端骨折治疗效果。方法 回顾2010 年3 月~2012 年1月间我院收治 的27 例桡骨远端严重粉碎骨折(观察组) ，术中以外固定架固定，牵开关节间隙，切开复位克氏针内固定骨折，术中应用关节镜进 行腕关节内观察，检测关节面对位情况，同时切断桡神经腕背支（骨间背侧神经），术后以X 线评估关节面对位，并随访腕关节功 能恢复情况，设同期收治常规手术复位治疗的桡骨远端严重粉碎骨折27 例(对照组) ，对比两组患者腕关节功能恢复情况。结果 治疗组手术时间明显缩短，患者术后关节面阶梯改变优于对照组，随访5~27 个月，根据Krimmer 评分表评估体系，治疗组腕关 节功能恢复情况优于对照组，组间比较差异显著（P0.05）。结论 外固定架下应用关节镜辅助治疗桡骨远端关节面骨折复位可 以避免关节面出现阶梯改变，最大程度恢复关节的功能，减轻创伤性关节炎。 关键词：桡骨远端骨折；关节镜；外固定架；克氏针；桡神经腕背支 中图分类号：R683.42 文献标志码：A 文章编号：1673-4254（2012）11-1680-03 doi: 10.3969/j.issn. 1673-4254.2012.11.036 Arthroscopy-assisted treatment of severe comminuted distal radial fracture using external fixators LI Honghan, YAN Kangning, ZHONG Zhihui, CHEN Jinlong, ZHENG Yiquan Department of Orthopedics, Zhangzhou Municipal Hospital Affiliated to Fujian Medical University, Zhangzhou 363000, China Abstract: Objective To evaluate the outcomes of arthroscopy-assisted treatment of severe comminuted distal radial fracture with external fixators and kirschner wire fixation. Methods Twenty-seven cases of severe comminuted distal radial fracture treated between March, 2010 and January, 2012 were reviewed. During the operation, the carpal joint space was expanded with the external fixator, and the fracture was fixed by Kirschner wire after open reduction. The carpal joint was observed intraoperatively with arthroscopy to ensure full reduction, and the distal posterior interosseous nerve was then severed. The results of postoperative X-ray and wrist functional status of the carpal joints were recorded. Another 27 cases of severe comminuted distal radial fracture treated by conventional surgical approach served as the cont