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目的 探讨不同类型桡骨远端Die-punch骨折的治疗效果.方法 2004年1月至2013年12月我们共收治48例桡骨远端Die-punch骨折患者.背侧型9例,掌侧型2例,劈裂型9例,塌陷型18例,塌陷伴劈裂型10例.移位型骨折37例,无明显移位型11例.手术治疗移位型34例,保守治疗无明显移位型11例和移位型拒绝手术3例.结果 术后随访时间为12～36个月,平均18个月,骨折均愈合.末次随访时,腕关节功能按Gartland-Werley评分法评定,仅3例功能恢复为中,其余均为优或良.3例功能恢复为中者,分别是1例移位塌陷伴劈裂型骨折因手术复位不满意和2例移位塌陷型骨折因拒绝手术采取保守治疗发生创伤性腕关节炎.无移位型骨折的腕关节功能恢复优良率高于移位型骨折,而移位型骨折中塌陷型和塌陷伴劈裂型的腕关节功能恢复优良率低于其他类型,差异均有统计学意义(P＜0.05).保守治疗组与手术治疗组的优良率比较,差异无统计学意义(P＞0.05).结论 不同类型、不同程度的Die-punch骨折治疗效果具有差异,移位的塌陷型或塌陷伴劈裂型是桡骨远端Die-punch骨折最严重的骨折类型,容易发生创伤性腕关节炎,从而影响腕关节的功能恢复.“,”Objective To explore the treatment effects for different types of die-punch fractures of the distal radius.Methods Forty-eight cases of die-punch fractures of the distal radius were treated from January 2004 to December 2013.There were 9 cases of dorsal type, 2 cases of volar type, 9 cases of split type, 18 cases of collapse type, and 10 cases of collapse with spht type.Thirty-seven cases had fracture displacement while 11 cases had no obvious fracture displacement.Surgical treatment was carried out in 34 cases of displaced fractures but declined in 3 cases.All 11 cases without obvious fracture displacement were conservatively treated.Results The surgical cases were follow-up for 12 to 36 months (average, 18 months) postoperatively.All fractures healed.At the last follow-up, functional recovery of the wrist was assessed using Gartland-Werley scoring system.All but 3 cases had excellent or good results.Among the 3 cases whose functional recovery was rated as fair, one case belonged to collapse with split type with fracture displacement and had unsatisfactory fracture reduction.The other 2 cases belonged to collapse type with fracture displacement but opted for conservative treatment instead of surgery.They developed traumatic arthritis.Functional outcomes in cases with fracture displacement were better than in cases without and fracture displacement.Displaced fractures in collapse type or collapse with split type had lower satisfactory rate than displaced fractures in other types.The differences were statistically significant (P ＜ 0.05).The excellent and good rates of conservative treatment and surgical treatment were not significantly different (P ＞ 0.05).Conclusion The treatment outcomes of varying types and varying degrees of die-punch fractures are different.Displaced collapse type or collapse with split type are the most severe types of die-punch fractures, which easily develop into traumatic arthritis of the wrist and affect functional recovery.