论文部分内容阅读
目的:探讨桡骨远端关节内骨折Doi分型临床应用可行性。方法:自2014年8月至2018年8月，我们切开复位接骨板内固定治疗桡骨远端关节内骨折共计79例，依据Doi分型术前对全部的病例进行CT平扫及三维重建评估，同时采用桡骨远端关节面六部分分区法确定骨折累及关节面范围及骨折块数量，并验证Doi分型，最终确定Doi分型是否能满足临床应用的需求。结果:79例桡骨远端关节内骨折患者中有60例使用Doi分型标准可准确地进行分型，另有19例患者尚不能使用Doi分型进行准确分型。根据桡骨远端关节面六部分分区法判定骨折累及关节面范围及骨折块数量，该19例无法用Doi分型的骨折类型分别为“两部分尺背侧型”18例和“两部分尺掌侧型”1例。桡骨远端关节面六部分中，乙状切迹区是关节内骨折最易受累区。结论:Doi分型方便关节镜下使用，但缺少两个亚型；我们增加两个亚型，完善Doi分型，更利于关节内骨折类型的准确判断，并指导治疗方案的选择。“,”Objective:To investigate the clinical application feasibility of Doi classification for intra-articular fractures of the distal radius.Methods:From August 2014 to August 2018, a total of 79 cases of intra-articular fractures of the distal radius were treated with open reduction and internal fixation. According to Doi classification, all the cases were evaluated by CT plain scan and three-dimensional reconstruction before operation. At the same time, the range of articular surface involved and the number of fracture blocks were determined by six-part partition method of distal radius articular surface, and the Doi classification was verified to determine whether the classification can be used to meet the needs of clinical application.Results:In the 79 cases of intra-articular fractures of the distal radius, 60 cases could be accurately classified by Doi classification standard, and 19 cases could not be accurately classified by Doi classification. According to the six-part partition method of distal radius articular surface, the range of articular surface involved and the number of fracture fragments were determined. The 19 cases of fracture which could not be classified by Doi classification were “two-part dorsal ulnar type” in 18 cases and “two-part ulnar palmar type” in 1 case. Among the six parts of the articular surface of the distal radius, sigmoid notch was the most vulnerable area for intra-articular fractures.Conclusion:Doi classification is convenient to use under arthroscopy, but lack of two subtypes; we add two subtypes to improve Doi classification, which is more conducive to accurate judgment of intra-articular fracture types and guide the selection of treatment scheme.