橈骨遠(yuǎn)端骨折的診治

IntroductionIndicationsApproachesTechniquesConclusionMainContentsIntroduction橈骨遠(yuǎn)端骨折：距橈骨遠(yuǎn)端關(guān)節(jié)面3cm以內(nèi)的骨折松質(zhì)骨與皮質(zhì)骨交接區(qū)，解剖薄弱區(qū)上肢骨折中最常見的骨折FirstnotedbyJ.L.Petitinthe18thcenturyRepresents16%ofallfracturesmanagedbyorthopaedicsurgeons

BucholzRW,etal.FracturesInAdults.LippincottWilliams&Wilkins,2010

Ourunderstandingofdistalradiusfracturesdevelopedovercenturies,butthetreatmentsremainedwithoutconsensus.Indications骨折端有肌肉或肌腱等軟組織嵌入

關(guān)節(jié)內(nèi)骨折手法復(fù)位未能達到功能復(fù)位的標(biāo)準(zhǔn)骨折合并血管、神經(jīng)損傷不穩(wěn)定性骨折多發(fā)骨折，便于護理和治療，防止并發(fā)癥陳孝平,汪建平.外科學(xué)[M].第8版.北京:人民衛(wèi)生出版社,2013:638..IndicationsIndicationsforoperativefixationin2000fracturescannotbeclosedorreducedunstablefracturesopenfracturespolytraumapatientsconcomitantcarpalfractureseverearticulardisplacementChungKC,etal.Predictorsoffunctionaloutcomesaftersurgicaltreatmentofdistalradiusfractures.JHandSurgAm.2001.IndicationsTheAmericanAcademyofOrthopedicSurgeons(AAOS)in2009Intra-articulardisplacementorstepoffgreaterthan2mmRadialshorteninggreaterthan3mmDorsaltiltgreaterthan10°fromneutralLichtmanDM,etal.Treatmentofdistalradiusfractures.JAmAcadOrthopSurg.2010.Indications新標(biāo)準(zhǔn)（AAOS，2014）Initialdorsalangulation>20°DorsalcomminutionRadiocarpalintra-articularinvolvementAssociatedulnafractureFractureswith>3factorsareassociatedwithsurgery

WattersWC,etal.TheAmericanAcademyofOrthopaedicSurgeonsAppropriateUseCriteriaonthetreatmentofdistalradiusfractures.JBoneJointSurgAm.2014.

Approaches背側(cè)入路橈側(cè)腕伸肌和拇長伸肌之間

Approaches掌側(cè)入路/“Henryapproach”橈側(cè)腕屈肌和橈動脈之間SatakeH,etal.Complications

of

Distal

RadiusFractures

Treated

by

Volar

Locking

Plate

Fixation.Orthopedics,

2016.

Approaches掌尺側(cè)入路

指淺屈肌和尺側(cè)腕屈肌之間固定骨折端的孤立性骨折橈骨莖突入路伸肌間隔之間固定橈骨莖突大的骨折塊其他

Techniques外固定支架SimilarfunctionaloutcomescomparedwithvolarplatingDecreasedoverthepast10yearsItcontinuestohavearoleinfracturesStabilizeahighlycomminutedfracturebeforeORIF

WilliksenJH,etal.Externalfixationandadjuvantpinsversusvolarlockingplatefixationinunstabledistalradiusfractures:arandomized,controlledstudywitha5-yearfollow-up.JHandSurgAm.2015.

RohYH,etal.Arandomizedcomparisonofvolarplateandexternalfixationforintra-articulardistalradiusfractures.JHandSurgAm.2015.

Techniques內(nèi)固定platesandscrewspintensionbandwiringhookplatesIntramedullarynail…..ChouYC,etal.Dorsalandvolar2.4-mmtitaniumlockingplatefixationforAOtypeC3dorsallycomminuteddistalradiusfractures.JHandSurgAm.2011.

TechniquesVolarplatingVolarplatinghasbecomethestandardofcareformost

distal

radiusfracturesVanhaeckeJ,FernandezDLDVRplatingof

distal

radiusfractures.Injury.

2015.TechniquesFragment-specificfixationAnalternativetreatmentoptionforcomplex,comminuted,articularfracturepatterns

TechniquesIntramedullarynailComparingwithvolarlockedplateItisbetterat6weeksaftersurgery,mid-termfunctionalandradiographicresultsweresimilar

SafiA,etal.Treatmentofextra-articularandsimplearticulardistalradialfractureswithintramedullarynailversusvolarlockingplate.JHandSurgEurVol,2013

TechniquesBonecementReduce2weekscomparedtothosetreatedwithcastingorexternalfixationfor6–8weeksCassidyC,etal.NorianSrscementcomparedwithconventionalfixationindistalradialfractures.Arandomizedstudy.JBoneJointSurgAm2003.TechniquesMinimallyinvasivepercutaneousplateosteosynthesis(MIPPO)techniqueasafeandeffectivesurgicaltreatmentmethodwithfewpotentialcomplicationsX.-m.Wei,etal.Orthopaedics&Traumatology:Surgery&Research,2016.

TechniquesArthroscopicassistance

arthroscopicallyassistedprocedureshadagreaterdegreeofsupination,flexion,andextensionVaritimidisSE,etal.Treatmentofintra-articularfracturesofthedistal