802 橈骨遠位端 骨折手術症例の検討 表1骨 図1症 折 のタイプ別症例数 例 タ イ プ はFrykman分 分 類Type4で 類Type8,Sarmiento あ り,末 梢 骨 片 の 掌 側 骨 皮 質 が 近 位 骨 片 背 側 に転 位 して いた.徒 手 整 復 後,径 2ミ リの
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1 Results of Percutaneous Pinning Method for the Factured Distal Radius Takashi Hiramatsu, Akihiro Kuba and Yukimasa Nishimura by Department of Orthopedic Surgery, Obama National Hospital Shigeyosi Yamaguchi Yamaguchi Orthopedic Clinic Thirty-two consecutive osteosyntheses by percutaneous pinning after prompt reduction for fractured distal radii were done in thirty-two patients in our hospital. Fourteen of them were followed physically and radiologically for an average of 14.7 months (range, five to seventy-seven months). Of these, four had minimal wrist pain on exercise, but no one had significantly impaired activities of daily living. The examinees showed various degrees of motion range, grip strength, and anatomical parameters of the joint. Grip strength and motion range were keys to postoperative outcome, and they were correlated. Also there was positive correlation between grip and degrees of supination and volar angles. Shortening of the radius was accompanied by poor supination and loss in volar angle. In conclusion, less deteriorated volar angle and less shortened radius were considered to be two major anatomical factors determining good prognosis in the management of the lesion in this series
2 802 橈骨遠位端 骨折手術症例の検討 表1骨 図1症 折 のタイプ別症例数 例 タ イ プ はFrykman分 分 類Type4で 類Type8,Sarmiento あ り,末 梢 骨 片 の 掌 側 骨 皮 質 が 近 位 骨 片 背 側 に転 位 して いた.徒 手 整 復 後,径 2ミ リの鋼 線 で経 皮 的 に骨 接 合 し た, してい な い場 合 の み,行 う.固 定 期 間 は0 9週,平 均2.8週 図2測 定 した 解剖 学 的 パ ラメ ー タ.一 次 パ ラ メ ー タの 定 義 は 文献1)に 依 っ た. で あ つた. 予後 調 査 は直接 検 診 に よっ て,疼 痛,握 力,ADL障 害,神 経 障 害 お よびROMを 調 べ た.ROMに 関 す るパ っ た が,握 力 が 大 き い 例 で はvolar angleとvariantが ラメ ー タは 診察 に よ って直 接 得 られ る値(掌 屈,背 屈, 健 側 に 近 い 値 を 示 し て い た(図3,a,b).握 回外,回 内,橈 屈,尺 屈)お の他 の解 剖学 的一 次 お よ び二 次 パ ラ メー タ とは有 意 な よび,そ の 術 側 健 側 比 を求 めた.次 に,解 剖学 的 パ ラメ ー タ として手 関 節X 関 係 が み ら れ な か っ た. 線 の 回外位 前後 像 と側面 像 か ら図2に 示 す パ ラ メ ータ 2)ROMと 解 剖 学 的 パ ラ メ ー タ:① を計 測 し,そ れ らの 健側 と術 側 との差(二 次パ ラ メー angleと タ)を 求 め た. 弱 く相 関 し て い た(図4,b).② これ らの デ ー タか ら,疼 痛,握 力 お よびROMと 解 相 関 し て お り(図4,a),radial ー タ と も 関 連 が な く,良 volar 剖 学 的 パ ラ メ ー タ間 の関 係 を調査 した. angleの れ(図4,c).④ 結 果 で 問題 とな る症例 は なか った ので,今 回 の術 後成 績 の 関係につい て分析 した. 1)握 5,a)お lengthと も のパ ラメ 好 に 保 た れ て い た.③ 回外は 大 きい 例 で は 可 動 域 も大 き い 傾 向 が み ら 回 内 は どの解 剖学 的パ ラ メー タ と も よ びSarmiento分 類 のType8(図 類 のType4(図5,b) で は 可 動 制 限 の あ る 症 例 が み ら れ た ⑤ 橈 屈 は ほ とん ど の 症 例 で 健 側 との 差 が な か っ た が,過 例 で はradial 力 と解剖 学 的 パ ラメ ー タ:有 意 な相 関 は な か 掌 屈 はvolar 背 屈 は,ど 関 連 が み ら れ な か っ た が,Frykman分 末 梢 神経 障 害 合併 例 は な く,ま た,疼 痛 も予 後 の 上 検 討項 目か ら除外 し,以 下 の1) 2)の 力 とそ (図5,c).⑥ angleの 度 に橈 屈 す る 値 が か な り小 さ い 例 が み ら れ た 尺 屈 はvariant差 お よ びradial width
3 -433-
4 -434-
5 -435-1) de Bruijn HP : Functional treatment of Colles fracture. Acta Orthop Scand, Suppl : 223, ) Frykman G : Fractures of the distal radius including sequelae-shoulder-hand-finger syndrome, disturbance of the distal radio-ulnar joint, impairment of nerve function ; a clinical and experimental study. Acta Orthop Scand, Suppl : 108, ) McQueen, M, Caspers J : Colles Fracture : Does
6 the anatomical result affect the final function? J Bone -Joint Sure 70-B: ,
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