桡骨远端骨折

桡骨远端骨折的诊治

IntroductionIndicationsApproachesTechniquesConclusionMainContentsIntroduction桡骨远端骨折：距桡骨远端关节面3cm以内的骨折松质骨与皮质骨交接区，解剖薄弱区上肢骨折中最常见的骨折FirstnotedbyJ.L.Petitinthe18thcenturyRepresents16%ofallfracturesmanagedbyorthopaedicsurgeons

BucholzRW,etal.FracturesInAdults.LippincottWilliams&Wilkins,2010

Ourunderstandingofdistalradiusfracturesdevelopedovercenturies,butthetreatmentsremainedwithoutconsensus.Indications骨折端有肌肉或肌腱等软组织嵌入

关节内骨折手法复位未能达到功能复位的标准骨折合并血管、神经损伤不稳定性骨折多发骨折，便于护理和治疗，防止并发症陈孝平,汪建平.外科学[M].第8版.北京:人民卫生出版社,2013:638..IndicationsIndicationsforoperativefixationin2000fracturescannotbeclosedorreducedunstablefracturesopenfracturespolytraumapatientsconcomitantcarpalfractureseverearticulardisplacementChungKC,etal.Predictorsoffunctionaloutcomesaftersurgicaltreatmentofdistalradiusfractures.JHandSurgAm.2001.IndicationsTheAmericanAcademyofOrthopedicSurgeons(AAOS)in2009Intra-articulardisplacementorstepoffgreaterthan2mmRadialshorteninggreaterthan3mmDorsaltiltgreaterthan10°fromneutralLichtmanDM,etal.Treatmentofdistalradiusfractures.JAmAcadOrthopSurg.2010.Indications新标准（AAOS，2014）Initialdorsalangulation>20°DorsalcomminutionRadiocarpalintra-articularinvolvementAssociatedulnafractureFractureswith>3factorsareassociatedwithsurgery

WattersWC,etal.TheAmericanAcademyofOrthopaedicSurgeonsAppropriateUseCriteriaonthetreatmentofdistalradiusfractures.JBoneJointSurgAm.2014.

Approaches背侧入路桡侧腕伸肌和拇长伸肌之间

Approaches掌侧入路/“Henryapproach”桡侧腕屈肌和桡动脉之间SatakeH,etal.Complications

of

Distal

RadiusFractures

Treated

by

Volar

Locking

Plate

Fixation.Orthopedics,

2016.

Approaches掌尺侧入路

指浅屈肌和尺侧腕屈肌之间固定骨折端的孤立性骨折桡骨茎突入路伸肌间隔之间固定桡骨茎突大的骨折块其他

Techniques外固定支架SimilarfunctionaloutcomescomparedwithvolarplatingDecreasedoverthepast10yearsItcontinuestohavearoleinfracturesStabilizeahighlycomminutedfracturebeforeORIF

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

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

Techniques内固定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