Objective: To explore the effectiveness of open reduction and internal fixation for bipolar fracture-dislocation of the forearm.
Methods: Between June 2014 and March 2019, 14 patients with bipolar fracture-dislocation of the forearm were treated. There were 9 males and 5 females, aged from 19 to 52 years (mean, 34.9 years). There were 8 cases of falling injuries, 4 cases of traffic accident injuries, 1 case of sports injury, and 1 case of machine strangulation injury. The time from injury to admission was 2-48 hours, with an average of 16.6 hours. All patients were closed injuries. All patients were treated with open reduction and internal fixation; the upper radioulnar joints were treated with circumferential ligament repair or lateral collateral ligament repair according to the joint stability. And the patients with lower radioulnar joint instability were also treated with the TightRope plate with loop fixation. After 3 weeks of plaster fixation, the patients started functional exercises. The fracture healing time, stability and range of motion of wrist and elbow joints, and forearm rotation function were recorded. The effectiveness was evaluated by Anderson's forearm function score at last follow-up.
Results: The incisions healed by first intention. All 14 cases were followed up 12-36 months with an average of 24.8 months. All fractures healed, with an average healing time of 14.9 weeks (range, 12-18 weeks). The stabilities of the upper and lower radioulnar joints restored well. At last follow-up, the elbow flexion and extension range of motion was 65°-160°, with an average of 124.6°; the wrist flexion and extension range of motion was 115°-165°, with an average of 155.0°; the forearm rotation range of motion was 65°-165°, with an average of 154.6°. According to Anderson's forearm function score, 8 cases were excellent, 5 cases were good, and 1 case was unsatisfactory.
Conclusion: The treatment of bipolar fracture-dislocation of the forearm needs comprehensive consideration and individualized treatment plan. The focus is to restore the anatomical structure of the radius and ulna and firm internal fixation, stabilize the upper and lower radioulnar joints, and perform functional exercises as soon as possible after operation to obtain satisfactory effectiveness.
目的: 探讨切开复位内固定治疗前臂双极骨折脱位的疗效。.
方法: 2014 年 6 月—2019 年 3 月，收治 14 例前臂双极骨折脱位患者。男 9 例，女 5 例；年龄 19～52 岁，平均 34.9 岁。致伤原因：高处坠落伤 8 例，交通事故伤 4 例，运动伤 1 例，机器绞伤 1 例。受伤至入院时间 2～48 h，平均 16.6 h。均为闭合性损伤。尺、桡骨骨折均切开复位内固定，上、下尺桡关节根据稳定程度选择修补环状韧带、外侧副韧带或者 TightRope 带袢钢板固定。术后石膏固定 3 周后，指导患者开始功能锻炼。记录骨折愈合时间，腕、肘关节稳定性及活动度、前臂旋转功能恢复情况。末次随访时，采用 Anderson 等的前臂功能评分标准评价疗效。.
结果: 术后切口均Ⅰ期愈合。14 例均获随访，随访时间 12～36 个月，平均 24.8 个月。X 线片复查显示骨折均愈合，愈合时间 12～18 周，平均 14.9 周。上、下尺桡关节稳定性均可。末次随访时，肘关节屈伸活动度为 65°～160°，平均 124.6°；腕关节屈伸活动度为 115°～165°，平均 155.0°；前臂旋转活动度为 65°～165°，平均 154.6°。根据 Anderson 等的前臂功能评分标准评价：优 8 例，良 5 例，不满意 1 例。.
结论: 前臂双极骨折脱位需选择个体化治疗方案，重点是恢复尺、桡骨解剖结构及坚强内固定，稳定上、下尺桡关节，术后尽早进行功能锻炼，才能获得满意的临床疗效。.
Keywords: Forearm injury; bipolar fracture; internal fixation; joint dislocation; open reduction.