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1、橈骨远端骨折畸形愈合合并远尺橈关节脱位治疗［摘要］目的:探讨橈骨远端截骨矫形、尺侧腕屈肌腱移位、腕背侧关节囊及伸肌支持带紧缩重建远尺橈关节治疗橈骨远端骨折畸形愈合合并远尺橈关节脱位的临床疗效。方法:21例橈骨远端骨折畸形愈合合并远尺橈关节脱位。骨折类型按A0橈骨远端骨折分类皆为A型，未合并远尺橈关节炎。行橈骨远端截骨后，在9”形臂下，橈骨高、掌倾角、尺偏角、远尺扌尧关节面对位恢复正常解剖位置，重建钢板固定，自体骼骨植骨。尺侧腕屈肌腱移位，腕背侧关节囊及伸肌支持带紧缩重建远尺橈关节。部分患者行旋前方肌松解。前臂旋后位克氏针固定。结果:21例患者均获随访，时间
2、15-24个月，平均19.3个月。术前前臂旋转活动度为(41.6±8.9)°,术后为(138.1±14.3)°;腕关节背伸术前为(9.2±4.2)°,术后为(33.2±11.8)°;腕关节尺偏活动度术前为(10.5±6.3)°,术后为(31.3±4.4)°oMayo评分结果:优10例，良7例，可4例。结论:应用橈骨远端截骨矫形术治疗尺侧腕屈肌腱移位，腕背侧关节囊及伸肌支持带紧缩重建远尺橈关节治疗橈骨远端骨折畸形愈合合并远尺橈关节脱位,手术效果良好，安全可靠。前臂旋转功能及腕关节各项运动功能得到有效恢复。［关键词］畸形愈合;远尺橈关节脱位;重建［中图分类号］
3、R684.7［文献标识码］A［文章编号]1673-7210(2010)01(c)-036-03TreatmentofmalunionofdistalradiusfracturescombinedwithdislocationofdistalradioulnarjointLIZihua,LIUYouyu,HUANGXuesong,QIUZhongpeng,ZHANGZhaoyi(DepartmentofHandSurgery,LiaoyangCentralHospitalofChinaMedicalUniversity,Liaoyiang111000,Chi
4、na)[Abstract]Objective:Toexploretheoutcomeofosteotomyandorthopedicofdistalradiusfractures,thereconstructionofdistalradioulnarjoint(DRUJ)withtranspositionofflexorcarpiulnaris(FCU),tighteningdorsalcarpalligamentsandextensorretinaculumsfortreatmentofmalunionsofdistalradiusfracturesco
5、mbinedwithdislocationofDRUJ.Methods:21patientsofmalunionofdistalradiusfracturescombinedwithdislocationofDRUJwereperformedoperations・AccordingtotheAOclassification,allfractureswereclassifiedastypeA.AllpatientsdidnotsufferfromarthritisofDRUJ.Theradiusosteotomyandanatomicalreductionw
6、ereperformedunderC-armtorestoretheradiusheight,palmartiltangle,ulnainclinationangle,correlationbetweenarticularsurfacesofDRUJ.Theosteotomizedradiuswerefixedwithreconstructionplates.Theauto-graftingfromtheiliacboneswereapplied.DRUJswerereconstructedwithtranspositionofFCUandtighteni
7、ngdorsalcarpalligamentsandextensorretinaculums・TheforearmsofsupinationwerefixedwiththeK-wires.Pronatorquadratuswerereleasedwithpartofthepatients.Results:21patientswerefollowedupfor15・24months,anaverageof19.3months・Therangeofmotionofforearmrotationwas(41.6±8.9)°preoperativelyand(13
8、8.1±14.3)°postoperatively,carpald
