掌侧锁定钢板结合背侧经皮克氏针翘拨治疗桡骨远端前后壁骨折的疗效评估

摘要 为探讨掌侧锁定钢板结合背侧经皮克氏针翘拨治疗桡骨远端前后壁骨折的临床疗效，通过回顾性研究方法，纳入从2014年1月至2018年1月收入治疗的桡骨远端前后壁均骨折的患者。最终共收入43例患者。其中男性16例，女性27例。平均年龄为64.39±4.85岁（范围51岁至74岁）。其中32例患者为自行摔伤，11例患者为交通事故伤。记录患者手术时长，术中出血量，术后4周，12周，24周视觉模拟评分，以及患者并发症，测量患者术后24周X线尺偏角，掌倾角，双手握力，腕关节主动活动范围及上肢功能评定标准(disabilities of the arm, shoulder and hand，DASH)评分、Gartland-Werley腕关节评分。结果表明手术时长平均为82.63±9.2 min，术中出血量平均为30.47±15.42 ml。术后4周VAS评分为3.98±0.8分，术后12周VAS评分为3.07±0.88分，术后24周VAS评分为1.93±1.24分，X线尺偏角为17.23±3.54度，X线掌倾角为11.83±1.35度，DASH评分为7.6±2.32分，Gartland-Werley腕关节评分为5.22±1.73分。握力为健侧38.56±5.96 kg，患侧34.23±6.27度，掌屈患侧70.34±7.49度，健侧79.59±6.16度，背伸患侧65.50±7.78度，健侧66.36±8.02度，桡偏患侧16.84±3.92度，健侧20.60±4.28度，尺偏患侧22.22±6.60度，健侧23.47±6.64度，旋前患侧70.75±7.97度，健侧74.75±8.97度，旋后患侧63.35±9.39度，健侧64.57±8.54。没有患者出现伤口感染、骨折复位丢失，以及内固定物断裂等并发症。可见掌侧锁定钢板结合背侧经皮克氏针翘拨治疗桡骨远端前后壁骨折的疗效满意，值得临床推广。

Efficacy evaluation of volar locking plate combined with dorsal percutaneous Kirschner wire for the treatment of anterior and posterior wall fractures of the distal radius

Abstract To investigate the clinical efficacy of volar locking plate combined with dorsal percutaneous Kirschner wire for the treatment of anterior and posterior walls fractures of the distal radius. A retrospective study was conducted patients with distal radius fractures of the anterior and posterior walls from January 2014 to January 2018. In the end, a total of 43 patients were included. There were 16 males and 27 females. The average age was 64.39 ± 4.85 years (range 51 to 74 years). Among them, 32 patients were self-injured and 11 patients were traffic accident injuries. The patient''s operation duration, intraoperative blood loss, postoperative 4 weeks, 12 weeks, 24 weeks visual analogue scale, and complications were recorded. The patient''s X-ray ruler angle, palm tilt angle, two-hand grip force, wrist joint initiative motion were measured 24 weeks after surgery. The range of activities and the disability of the arm, shoulder and hand (DASH) score, and the Gartland-Werley wrist score were also recorded. The results showed that the average length of operation was 82.63±9.2 min, and the average amount of intraoperative blood loss was 30.47±15.42 ml. The VAS score was 3.98±0.8 points at 4 weeks postoperatively, and the VAS score was 3.07±0.88 points at 12 weeks postoperatively. The VAS score was 1.93±1.24 points at 24 weeks postoperatively, and the X-ray ruler angle was 17.23±3.54 degrees. The palm tilt angle was 11.83 ± 1.35 degrees, the DASH score was 7.6 ± 2.32, and the Gartland-Werley wrist score was 5.22 ± 1.73. The grip strength was 38.56±5.96 kg on the healthy side, 34.23±6.27 kg on the affected side. the palmar flexion was 70.34±7.49 degrees on the affected side and 79.59±6.16 degrees on the healthy side. Dorsiflexion were 65.50±7.78 degrees on the affected side and 66.36±8.02 degrees on the healthy side. Radial deviation was 16.84±3.92 degrees on the affected side and the healthy side was 20.60±4.28 degrees. Ulnar deviation was 22.22±6.60 degrees on the affected side and the healthy side was 23.47±6.64 degrees. the pronation was 70.75±7.97 degrees on the affected side and the healthy side was 74.75±8.97 degrees. Supination of affected side was 63.35. ± 9.39 degrees and healthy side was 64.57± 8.54. No patients had complications such as wound infection, loss of fracture reduction, and fracture of internal fixation. It can be seen that the volar locking plate combined with the dorsal percutaneous Kirschner wire for the treatment of anterior and posterior wall fractures of the distal radius is satisfactory and worthy of clinical promotion.