端只有两个孔,粉碎的SchatzkerTile Ⅲ型骨折常有固定不到的骨块。总结各种内固定方法的优缺点,我们采取了以下治疗策略:(1)对SchatzkerTile Ⅱ、Ⅲ型骨折,如果微型T形掌骨或指骨钢板置于“安全区”内能覆盖各骨折块的,使用微型钢板固定支撑固定。(2)骨折块位于“安全区”外的SchatzkerTile Ⅱ型骨折,使用微型指骨螺钉并使用埋头器将螺钉帽埋入软骨下,使其不影响上尺桡关节的活动。(3)SchatzkerTile Ⅲ型骨折,即使“安全区”外有骨折块的仍将钢板置于“安全区”内,通过螺钉不能固定骨折块即加用细克氏针固定,克氏针尾留于皮外。如果克氏针对功能锻炼带来不便,跟据复查时骨折愈合的情况尽早拔除。本组中1例为SchatzkerTile Ⅲ型骨折,部分骨折块在安全区外,在安全区内使用微型钢板后又加用多根细克氏针固定,术后前臂旋转功能锻炼受到克氏针限制,因骨折粉碎严重拔除克氏针时间延长至6周,评分<80分,功能恢复不理想;而其他加用克氏针的病例在术后3周拔除克氏针,功能恢复良好。
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