目的:评估使用锁定钢板治疗桡骨远端不稳定骨折的疗效。方法:2005年8月至2009年5月使用锁定钢板治疗桡骨远端不稳定性骨折27例。平均553岁。按AO分类:B2型5例,B3型2例,C1型11例,C2型7例,C3型2例。结果:全部病例得到3～24个月随访,平均162个月。根据Fernandez评分标准进行腕关节功能评分:优14例,良10例,一般1例,差2例。优良率875％。 结论:掌侧锁定钢板治疗桡骨远端不稳定性骨折是安全有效的治疗选择,可提供坚强的固定,早期功能训练。
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 explore the application of improved carpal shoot through view (ICSTV) method in the treatment of distal radius fractures with volar plate internal fixation. Methods The clinical data of 67 patients with distal radius fractures who met the selection criteria between January 2020 and January 2023 was retrospectively analyzed. There were 30 males and 37 females with an average age of 53.6 years (range, 18-75 years). According to the AO/Orthopaedic Trauma Association (AO/OTA) classification, there were 25 cases of type B and 42 cases of type C. The time from injury to operation ranged from 2 to 6 days, with an average of 3.8 days. During the operation, bilateral cortical drilling was performed, and the length of the implanted screw was 1-2 mm shorter than that measured by the depth ruler. Standard anteroposterior and lateral (AAL) fluoroscopy and ICSTV fluoroscopy were performed after volar anatomic locking plate fixation, respectively. If the dorsal cortex of the distal radius was detected to be penetrated, the short screw was replaced and ICSTV fluoroscopy was performed again until no screw was penetrated. The detection rate of dorsal cortical screw penetration was compared between AAL fluoroscopy and ICSTV fluoroscopy. Postoperative CT scan was performed to confirm the presence or absence of dorsal cortical screw penetration. Results Intraoperative AAL fluoroscopy found 5 screws penetrating the dorsal cortex in 4 patients (6.0%), and ICSTV fluoroscopy found 19 screws penetrating the dorsal cortex in 15 patients (22.4%) including the above 4 patients, with a significant difference in the detection rate between the two fluoroscopy methods [OR=0.267 (0.084, 0.845), P=0.018]; 15 patients were replaced with short screws during operation. At the same time, ICSTV fluoroscopy detected 2 screws penetrating into the distal radioulnar joint in 2 cases (3.0%), which could not be found in AAL fluoroscopy, and the direction of the screws was adjusted and replaced. All patients were reexamined by wrist CT within 3 days after operation, and no dorsal cortical screw penetration or screw penetration into the distal radioulnar joint was found. All the 67 patients were followed up 6-18 months, with an average of 11.3 months. Extensor tendon irritation occurred in 2 patients at 3 months after operation, and no extensor tendon rupture occurred in all patients during follow-up. All fractures healed well, and the healing time was 8-13 weeks, with an average of 10.8 weeks. There was no complication such as internal fixation loosening or fracture displacement. The Gartland-Werley score at last follow-up ranged from 0 to 15, with an average of 5.6. ConclusionICSTV fluoroscopy can effectively detect occult dorsal cortical screw penetration of the distal radius that can not be revealed by AAL fluoroscopy.