桡骨远端骨折治疗的研究进展

汪志中 麦彩园 王斌 李新旭

[摘要] 桡骨远端骨折是常見的骨折之一，多发于中老年和青少年。多种方法可以用来治疗桡骨远端骨折，有观点坚持钢板内固定内固定比夹板、石膏外固定能更早地活动及功能锻炼;也有观点认为克氏针、外固定支架固定能将开放手术的风险降低;对于老年人，骨质疏松多见，建议对此人群行闭合手法复位石膏、夹板或支具外固定。常用的固定及材料为石膏夹板或支具外固定、经皮穿刺闭合克氏针固定、外固定支架固定、内固定、植入人工腕关节假体。而内固定种类包括接骨板、骨折特异性固定、背侧牵引接骨板、髓内钉等。切开复位内固定两种传统的手术入路分为掌、背侧入路。近年来骨替代物、腕关节镜辅助、3D打印应用于桡骨远端骨折。桡骨远端骨折治疗方法多样，每种治疗方法都有其适用特点及优缺点，而且治疗需据骨折类型、年龄、活动水平进行个体化定制，本文对其进行综述。

[关键词] 桡骨远端骨折;内固定;外固定;进展

[中图分类号] R687.3          [文献标识码] A          [文章编号] 1673-9701（2021）30-0180-04

[Abstract] Distal radius fractures are one of the common fractures and mostly occur in the middle-aged， the elderly and adolescents. A variety of methods can be used to treat distal radius fractures. There are opinions emphasizing that steel plate internal fixation can achieve earlier movement and functional exercise than splints and plaster external fixation. There are also opinions that Kirschner wires and external fixator can reduce the risk of open surgery to the minimum. For the elderly， osteoporosis is more common， and it is recommended that this population should undergo closed reduction and external fixation with plaster， splint or brace. In terms of commonly used fixation and materials， there is external fixation with plaster， splint or brace， percutaneous puncture closed internal fixation with Kirschner wire， fixation with external fixator， internal fixation， and implantation of artificial wrist joint prosthesis. The types of internal fixation include bone plates， fracture-specific fixation， dorsal traction plates， intramedullary nails， etc. There are two traditional surgical approaches for open reduction and internal fixation， namely volar and dorsal approaches. In recent years， bone substitutes， wrist arthroscopy assistance， and 3D printing have been applied to distal radius fractures. There are various treatment methods for distal radius fractures. Each treatment method has its applicable characteristics， advantages and disadvantages， and the treatment needs to be customized according to the type of fracture， the patient′s age and the level of motion. This paper reviews the treatment methods for distal radius fractures.

[Key words] Distal radius fractures; Internal fixation; External fixation; Progress

桡骨远端骨折指骨折线距离桡骨远端关节面小于3 cm的骨折，是最常见的骨折之一，多发于中老年和青少年，发病率约占全部骨折的15%[1]。治疗不当会引起腕关节活动差或疼痛，因此选择适当的治疗方法非常关键[1-2]。桡骨远端骨折治疗方法多样。近年来锁定接骨板的应用在一定程度上改变了相关的治疗理念，复杂桡骨远端骨折的治疗方案有所改善，接受切开复位内固定手术的患者逐年增加。……