目的 比较外固定支架与锁定加压钢板（LCP）治疗桡骨远端die-punch骨折的疗效及适应证。 方法 2007年1月－2011年1月，分别采用外固定支架和LCP治疗桡骨远端die-punch骨折32例36侧，其中LCP固定19侧，外固定支架固定17侧。两组患者性别、年龄、致伤原因、骨折分类、伤后至入院时间等一般资料比较差异无统计学意义（P＞0.05）。术中对塌陷的关节面均采取撬拨植骨的方法恢复桡腕关节，克氏针固定较大骨折块。比较两种方法手术前后掌倾角、尺偏角、桡腕关节面恢复情况、骨折愈合时间，术后腕关节活动范围等。 结果 两组患者手术切口均Ⅰ期愈合，无感染发生。患者术后均获随访，随访时间6～24个月，平均13个月。所有患者骨折愈合良好，愈合时间、术后6个月X线片掌倾角、尺偏角两组间差异均无统计学意义（P＞0.05）；术后6个月腕关节尺偏活动度分别为（20.8 ± 3.6）°和（18.0 ± 2.8）°，LCP组优于外固定支架组（P＜0.05）；LCP组和外固定支架组桡骨高度分别为（10.9 ± 2.8）mm和（13.4 ± 2.3）mm，Gartland-Werley评分分别为（5.3 ± 2.4）分和（8.4 ± 3.6）分，两组差异有统计学意义（P＜0.05）。 结论 对于桡骨远端die-punch骨折，LCP可提供有效固定及早期活动，但对于关节面的塌陷及桡骨高度的恢复，外固定支架固定可提供良好的支撑作用。对于严重die-punch骨折可联合运用LCP和外固定支架等技术。
Objective To analyze the effectiveness of volar locking compression plate (LCP) and radial styloid process plate for the treatment of type C fractures of the distal radius. Methods Between May 2010 and May 2011, 24 cases of type C fractures of the distal radius were treated, including 8 males and 16 females with an average age of 52 years (range, 23-73 years). Injury was caused by falling in 20 cases and by traffic accident in 4 cases. All were fresh closed fractures. The locations were the left side in 15 cases and the right side in 9 cases. According to AO typing, there were 16 cases of type C2 and 8 cases of type C3. The preoperative palmar tilt angle ranged from — 60 to 25° (mean, — 45.3°); the preoperative ulnar inclination angle ranged from — 16 to 13° (mean, 8.2°); and the preoperative radial length shortening was 8-18 mm (mean, 12 mm). The time from injury to operation was 3-10 days (mean, 5.2 days). Results All operation incisions healed primarily. All patients were followed up 9-16 months (mean, 13.5 months). The healing time of fracture was 8-12 weeks (mean, 10.2 weeks). The articular surface was smooth and the radial length was recovered. The postoperative palmar tilt angle ranged from 8 to 15° (mean, 12.3°); the postoperative ulnar inclination angle ranged from 18 to 26° (mean, 22.3°). No loss of reduction, refracture, or carpal tunnel syndrome occurred during follow-up. The average range of motion of the wrist was 45.3° (range, 30-70°) in dorsal extension, was 50.2° (range, 26-78°) in palmar flexion, was 13.5° (range, 8-25°) in radial inclination, was 23.6° (range, 15-32°) in ulnar inclination, was 65.7° (range, 35-90°) in pronation, and was 72.5° (range, 20-90°) in supination at last follow-up. According to the wrist function by Gartland-Werley scoring, the results were excellent in 12 cases, good in 8 cases, and fair in 4 cases; and the excellent and good rate was 83.3%. Conclusion Treatment of type C fractures of the distal radius with volar LCP and radial styloid process plate can reconstruct normal anatomic structures and get good functional recovery.
Objective To discuss the relationship between recovery of anatomical integrity and functional outcome in elderly patients with distal radius fractures by comparing the effects of open reduction and closed reduction. Methods The cl inical data were retrospectively analyzed from 78 elderly patients with distal radius fractures treating with nonoperation andoperation from February 2005 to March 2009. Thirty-seven patients underwent closed reduction and spl intlet fixation or cast appl ication (non-operation group), and forty-one patients underwent open reduction and internal fixation (operation group). In non-operation group, there were 15 males and 22 females with an average age of 73 years (60-83 years). According to the AO classification system for fracture, there were 8 cases of type A2, 7 cases of type A3, 7 cases of type B1, 4 cases of type B2, 2 cases of type B3, 4 cases of type C1, 2 cases of type C2, and 3 cases of type C3. The time from injury to admission was between 30 minutes and 3 days with a mean time of 1 day. In operation group, there were 18 males and 23 females with an average age of 71 years (62-80 years). According to the AO classification system for fracture, there were 5 cases of type A2, 7 cases of type A3, 7 cases of type B1, 6 cases of type B2, 3 cases of type B3, 4 cases of type C1, 5 cases of type C2, and 4 cases of type C3. The time from injury to admission was between 30 minutes and 7 days with a mean time of 1 day. There were no significant differences (P gt; 0.05) in sex, age, disease course and fracture classification between two groups. Results All incisions obtained heal ing by first intention after operation in operation group. All patients were followed up for 9-36 months (20 months on average). Fracture heal ing was achieved within 8 to 15 weeks, with an average of 11 weeks. There were no significant differences (P gt; 0.05) in fracture heal ing time between non-operation group [(10.8 ± 2.0) weeks] and operation group [(11.7 ± 2.5) weeks]. At last follow-up, thepalmar tilt angle was (5.6 ± 2.0)° and (8.6 ± 3.0)°, the radial incl ination angle was (19.1 ± 4.9)° and (21.8 ± 2.0)°, and the radial length was (8.3 ± 1.3) mm and (10.4 ± 1.4) mm in non-operation group and operation group, respectively; showing significant differences (P lt; 0.05) between two groups. According to the Gartland-Werley score, the results were excellent in 9 cases, good in 21 cases, fair in 5 cases, and poor in 2 cases in non-operation group, the excellent and good rate was 81.1%; in operation group, the results were excellent in 13 cases, good in 25 cases, fair in 2 cases, and poor in 1 case, the excellent and good rate was 92.7%, showing no significant difference (P gt; 0.05) between two groups. There were no significant differences (P gt; 0.05) in flexion and extension activity of wrist, radioulnar partial activity, pronation-supination activity, grip and pinch strength between two groups. Conclusion Open reduction and closed reduction can achieve satisfactory functional outcomes, but closed reduction was inferior to open reduction in anatomic reduction for treating distal radius fractures in elderly patients.
ObjectiveTo compare the effectiveness of external fixation and volar locking compression plate in the treatment of distal radius fractures of type C. MethodsBetween March 2012 and March 2013, 122 patients with distal radius fractures of type C were enrolled in the prospective randomized study. Fractures were treated by external fixation in 61 patients (external fixation group) and by open reduction and internal fixation using a volar locking compression plate in 61 patients (plate group). There was no significant difference in age, gender, fracture side, weight, height, body mass index, fracture type, and interval of injury and operation between 2 groups (P>0.05). The blood loss, operation time, hospitalization days, fracture union time, wrist function, and complications were compared between 2 groups. And the quality of reduction was observed, including volar tilting angle, ulnar deviation, radial height, and articular reduction. ResultsThe blood loss, operation time, and hospitalization days in plate group were significantly higher than those in external fixation group (P<0.05). All of the patients in both groups were followed up 12-28 months. Postoperative complications occurred in 4 patients (6.6%) of external fixation group (pin tract infection in 2 cases and radial nerve neuritis in 2 cases) and in 5 patients (8.2%) of plate group (wound infection in 1 case, carpal tunnel syndrome in 2 cases, and tendon rupture in 2 cases), showing no significant difference between 2 groups (P=0.500). The X-ray films showed fracture healing in all patients of 2 groups; the union time of plate group was significantly longer than that of external fixation group (P<0.05). At last follow-up, there was no significant difference in ulnar deviation and radial height between 2 groups (P>0.05), but the volar tilting angle of plate group was significantly larger than that of external fixation group (P<0.05). There was no significant difference in wrist function and articular reduction between 2 groups (P>0.05). ConclusionFor distal radius fractures of type C, the use of external fixation or volar locking compression plate can obtain satisfactory clinical outcomes, but the external fixation has the advantages of less invasion, shorter hospitalization days, minor complications, and faster fracture union.
目的:评价外固定支架治疗桡骨远端骨折的疗效。方法:2004年3月至2008年8月以外固定支架或辅以克氏针、可吸收螺钉内固定治疗桡骨远端骨折３7例。结果:31例获得4～28 个月(平均14 个月)的随访,所有骨折均临床愈合,平均愈合时间8周。腕关节功能按Sarmiento标准进行评定,优17例,良9例,可4例,差1例,优良率839%。结论:外固定支架治疗桡骨远端骨折疗效可靠,值得推广。
Objective To systematically review the value of ultrasound in the diagnosis of fracture of the distal radius and ulna for providing evidence for clinical diagnosis. MethodsWe searched PubMed, EMbase, The Cochrane Library (Issue 7, 2016), CNKI, CBM and WanFang Data databases for studies about ultrasound in the diagnosis of fracture of the distal radius and ulna from inception to August 1st, 2016. Two reviewers independently screened literatures according to inclusion and exclusion criteria, extracted data, and assessed the risk of bias of included studies by using the QUADAS-2 (Quality Assessment of Diagnostic Accuracy Studies 2) tool, and then meta-analysis was performed by using Meta-Disc 1.4 software. ResultsA total of 16 articles involving 1 182 patients and 631 fractures were included. The results of heterogeneity test revealed that there was statistical heterogeneity among the results of studies, thus, random effects model was used for meta-analysis. The results of meta-analysis showed that the pooled sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, diagnosis odds ratio for ultrasound diagnosis fracture of the distal radius and ulna were 0.95 (95%CI 0.94 to 0.97), 0.92 (95%CI 0.89 to 0.94), 9.98 (95%CI 5.20 to 19.15), 0.07 (95%CI 0.04 to 0.13), 187.94 (95%CI 65.67 to 537.84), respectively. The area under the SROC curve was 0.976 4. ConclusionUltrasound is a useful non-invasive method as a routine examination for fracture of the distal radius and ulna. Due to the limited quality and quantity of included studies, the above conclusion is needed to be validated by more high-quality studies.
Objective To investigate the effectiveness of LARS ligament and three-dimensional (3D) printed prosthesis on the combined reconstruction of radial hemicarpal joint after distal radius tumor resection. Methods The clinical data of 12 patients with combined reconstruction of radial hemicarpal joint with LARS ligament and 3D printed prosthesis after distal radius tumor resection between September 2017 and March 2021 were retrospectively analyzed. There were 7 males and 5 females with an average age of 41.8 years (range, 19-63 years). There were 8 cases on the left side and 4 cases on the right side, and 10 cases of giant cell tumor of bone and 2 cases of osteosarcoma. The disease duration ranged from 1 to 20 months, with an average of 8.1 months. The osteotomy length, operation time, and intraoperative blood loss were recorded, and the wrist function was evaluated by Mayo wrist score and Musculoskeletal Tumor Society (MSTS) score before and after operation. The grip strength of the affected limb was expressed by the percentage of grip strength of the healthy upper limb, and the range of motion (ROM) of the wrist joint was measured, including extension, flexion, radial deviation, and ulnar deviation; the bone ingrowth and osseointegration at the bone-prosthesis interface of the wrist joint were observed by radiographic follow-up; the possible wrist complications were recorded. ResultsAll 12 patients successfully completed the operation. The osteotomy length was 5.0-10.5 cm (mean, 6.8 cm), and the operation time was 180-250 minutes (mean, 213.8 minutes). The intraoperative blood loss was 30-150 mL (mean, 61.7 mL). All patients were followed up 11-52 months (mean, 30.8 months). Radiographic follow-up showed that bone ingrowth and osseointegration at the bone-prosthesis interface were observed in all patients, and biological fixation was gradually achieved. During the follow-up, the stability, motor function, and ROM of the wrist joint were good. There was no complication such as arthritis, subluxation, prosthesis loosening, and infection, and no tumor recurrence and metastasis. At last follow-up, the Mayo score was 82.1±5.4, and MSTS score was 27.5±1.5, which were significantly improved when compared with those before operation (48.8±13.5, 16.4±1.4; t=−10.761, P<0.001; t=−26.600, P<0.001). The grip strength of the affected side was 59%-88% of that of the healthy side, with an average of 70.5%. The ROM of wrist joint were 55°-80° (mean, 65.42°) in extension, 35°-60° (mean, 44.58°) in flexion, 10°-25° (mean, 17.92°) in radial deviation, 10°-25° (mean, 18.33°) in ulnar deviation. Conclusion The combined application of LARS ligament and 3D printed prosthesis is an effective way to reconstruct bone and joint defects after distal radius tumor resection. It can improve the function of wrist joint, reduce the incidence of complications, and improve the stability of wrist joint.