分期外固定与经皮钢板固定开放性前臂双骨干骨折△

Staged external fixation and percutaneous plate for fixation of open fracture of the forearm

摘要:

[目的] 介绍分期外固定与经皮钢板固定开放性前臂双骨干骨折的手术技术和初步临床效果。[方法] 对12 例开放性前臂双骨干骨折患者采用分期外固定和经皮钢板内固定术。一期外固定架维持骨折对线，二期在尺、桡骨折远近两端沿骨长轴各作两个微创经皮“窗口”，在肌肉与肌腱之间分离至骨膜，骨膜剥离子在骨膜外分离跨骨折线制作预放钢板的“隧道”，从远端“窗口”插入钢板至骨折近端，透视下进一步骨折对位后钻孔、置入螺钉。术后早期行前臂旋转功能康复。[结果] 12 例患者均顺利完成手术，无严重并发症，一期与二期手术间隔时间平均（21.1±6.1） d。所有患者均获随访，随访时间12~26 个月。桡骨平均愈合时间（4.3±1.1） 个月，尺骨平均愈合时间（4.0±1.4） 个月。末次随访根据Grace-Eversmann 评分标准，优9例，良2 例，可1 例，优良率为91.7%。[结论] 利用初期外固定架辅助间接复位，使微创钢板接骨术治疗前臂双骨干骨折操作安全可靠，临床疗效满意。

Abstract:

[Objective] To introduce the surgical techniques and preliminary clinical results of staged external fixation and percutane-ous plate fixation for open double shaft fractures of the forearm. [Methods] A total of 12 patients were treated with staged external fixationand percutaneous plate internal fixation for open forearm double shaft fractures. In the first stage an external fixator was applied to maintainfixation and forearm alignment, while in the second stage, two minimally invasive percutaneous "windows" were made on each end of the ul-nar fracture and the radial fracture along the long axis of bone, separating the muscle and tendon to the periosteum. The periosteum stripperwas used to separate extra-periosteum to make a "tunnel" and the plates were inserted from the distal "window" to the proximal "window"respectively. After further reduction under fluoroscopy, drilling and screw placement were carried out. Early postoperative rehabilitation offorearm rotation function was performed. [Results] All the 12 patients had two stages of surgical procedures performed successfully withoutserious complications with an average interval between the first and second stages of (21.1±6.1) days. All patients were followed up for 12 to26 months. The radius got healing in (4.3±1.1) months, while the ulna was of (4.0±1.4) months on a mean. According to the Grace-Evers-mann criteria, the clinical outcomes at the latest follow-up were marked as excellent in 9 cases, good in 2 cases, and fair in 1 case, with ex-cellent and good rate of 91.7%. [Conclusion] Using the initial external fixator to assist indirect reduction, the percutaneous plate fixation issafe and reliable, and does achieve satisfactory clinical efficacy for double shaft fractures of the forearm.