桡骨远端不稳定骨折的治疗策略

目的：探讨桡骨远端不稳定骨折的最佳治疗方案，以便能够获取更好的功能康复。方法：2007年1月-2011年12月共收治桡骨远端不稳定骨折51例，其中采用外支架撑开复位外固定5例，后路复位钢板内固定治疗23例，前路钢板固定17例，前后路联合固定6例，术后均早期进行关节功能锻炼。结果：51例均获得随访，X片提示均已骨性愈合。采用Gartland和Werley评分系统评估腕关节功能，其中外支架固定，优1例，良1例，中2例，差1例，优良率40％；后路固定，优12例，良6例，中3例，差2例，优良率78-3％；前路固定，优9例，良6例，中1例，差1例，优良率88．2％；前后路联合，优2例，良1例，中2例。差1例，优良率50％。结论：桡骨远端不稳定骨折正确的手术策略能够获得更好的功能恢复，其中前路手术固定效果优于后路固定。

Treatment of Unstable Distal Radius Fracture Strategy

Objective： To investigate the optimal treatment project of unstable fractures of distal radius, and obtain better function rehabilitation. Methods： 51 patients with unstable fracture of distal radius from January 2007 to December 201 lwere collected, including 5 cases treated with distraction reduction and external fixation by external fixator, 23 cases treated with posterior open reduction and internal fixation by plate, 17 cases treated with anterior open reduction and internal fixation by plate, and 6 cases with combined anterior and posterior fixation 6 cases, all the patients with postoperative early joint functional exercise. Results： All cases were followed up and acquired bony union by X-ray. The Gartland and Werley rating system were adopted to assess wrist function m. In the group of external fixation, excellent in 1 case, good in 1 case, fair in 2 cases, and poor in lcase, the percentage of excellent and good is 40 %. In the group of posterior fixation, excellent in 12 cases, good in 6 case, fair in 3 cases, and poor in 2 case, the percentage of excellent and good is 78.3 %; In the group of anterior fixation, excellent in 9 cases, good in 6 cases, fair in 1 case, and poor in 1 case, the percentage of excellent and good is 88.2 %. In the group of combined anterior and posterior fixation, excellent in 2 cases, good in 1 case, fair in 2 cases, and poor in lcase, the percentage of excellent and good is 50 %. Conclusion： Better function recovery could be obtained by correct Surgical strategy on unstable fractures of distal radius, and anterior fixation is better than posterior fixation.