尺骨茎突骨折愈合对桡骨远端骨折术后关节功能影响
|
摘要
目的观察尺骨茎突骨折愈合情况短期内对桡骨远端骨折内固定术后腕关节功能的影响。方法回顾性分析2012年6月至2013年6月于聊城市中医医院收治的136例单侧不稳定的桡骨远端骨折伴尺骨茎突骨折患者的临床资料,所有患者均采用锁定钢板固定桡骨骨折,根据尺骨茎突骨折愈合情况将患者分为尺骨茎突骨折愈合组(愈合组,n=43)和尺骨茎突骨折未愈合组(未愈合组,n=93)。根据术后X线正侧位片测量并记录患者桡骨高度(桡骨茎突与尺骨茎突之差)、掌倾角、尺偏角,评价桡骨骨折复位、愈合情况和尺骨茎突愈合情况,记录腕关节尺侧旋转疼痛的患者数量。末次随访时采用Gartlant-Werley评分和臂肩手功能障碍评分(DASH)评分评估腕关节功能,测定并记录腕关节的活动范围及握力。性别、骨折类型等计数资料比较采用卡方检验,时间、DASH评分等计量资料比较采用t检验。结果两组患者在年龄、性别、受伤至手术时间、骨折内固定研究学会(AO)骨折分型、受伤侧别和致伤原因方面比较差异无统计学意义(P> 0. 05)。尺骨茎突骨折愈合组尺侧旋转疼痛有18例(41. 9%),而未愈合组有40例(43. 0%),差异无统计学意义(χ~2=1. 021,P> 0. 05)。两组患者的住院时间、桡骨骨折愈合时间、掌倾角、尺偏角和桡骨高度方面比较,差异无统计学意义(P>0. 05),具有可比性。两组患者背伸、掌曲、桡偏、尺偏、握力和DASH评分、Gartlant-Werley评分和优良率方面比较差异无统计学意义(P> 0. 05)。结论尺骨茎突骨折愈合情况在短期内对桡骨远端骨折内固定术后腕关节功能的康复无明显影响。
Objective To observe the effect of healing of ulnar styloid fracture in short term on wrist function after internal fixation of distal radius fracture. Methods The clinical data of 136 patients with unstable unilateral distal radius fractures and ulnar styloid process fractures admitted in Traditional Chinese Medicine Hospital of Liaocheng from June 2012 to June 2013,were analyzed retrospectively. All the patients were treated with locking plate for radius fracture. According to the healing status of ulnar styloid process,the patients were divided into group A( the ulnar styloid fracture healed,n = 43) and group B( ulnar styloid fracture did not heal,n = 93). According to the postoperative X-ray radiographs,the height of the radius( the difference between the radial styloid process and the ulnar styloid process),the angle of the palm,and the deviation of the radius were recorded; the healing of the radial fracture and the healing status of the ulnar styloid process were evaluated. The number of patients with ulnar joint rotation pain was also recorded. At the last follow-up,the Gartlant-Werley score and the disabilites of the arm,shoulder and hand( DASH) score were used to assess the wrist function,and the range and wrist of the wrist were measured and recorded. The counting data were compared by Chi-square test and the measurement data were compared by t test. Results There was no significant difference in age,sex,injury to operation time,fracture classification,injury side or cause of injury between the two groups( P > 0. 05). There were 18 cases( 41. 9%) of ulnar joint rotation pain in group A and 40 cases( 43. 0%) in group B,the difference was not statistically significant( χ~2=1. 021,P > 0. 05). There was no statistically significant difference in the length of hospital stay,fracture healing time,palm tilt angle,ulnar angle or radius height of the two groups( P > 0. 05). There was no significant difference in Gartlant-Werley score or the excellent and good rate between the two groups( P >0. 05). Conclusion The healing of ulnar styloid process may not be affected in the short term on the rehabilitation of wrist joint after distal radius fracture fixation.
Objective To observe the effect of healing of ulnar styloid fracture in short term on wrist function after internal fixation of distal radius fracture. Methods The clinical data of 136 patients with unstable unilateral distal radius fractures and ulnar styloid process fractures admitted in Traditional Chinese Medicine Hospital of Liaocheng from June 2012 to June 2013,were analyzed retrospectively. All the patients were treated with locking plate for radius fracture. According to the healing status of ulnar styloid process,the patients were divided into group A( the ulnar styloid fracture healed,n = 43) and group B( ulnar styloid fracture did not heal,n = 93). According to the postoperative X-ray radiographs,the height of the radius( the difference between the radial styloid process and the ulnar styloid process),the angle of the palm,and the deviation of the radius were recorded; the healing of the radial fracture and the healing status of the ulnar styloid process were evaluated. The number of patients with ulnar joint rotation pain was also recorded. At the last follow-up,the Gartlant-Werley score and the disabilites of the arm,shoulder and hand( DASH) score were used to assess the wrist function,and the range and wrist of the wrist were measured and recorded. The counting data were compared by Chi-square test and the measurement data were compared by t test. Results There was no significant difference in age,sex,injury to operation time,fracture classification,injury side or cause of injury between the two groups( P > 0. 05). There were 18 cases( 41. 9%) of ulnar joint rotation pain in group A and 40 cases( 43. 0%) in group B,the difference was not statistically significant( χ~2=1. 021,P > 0. 05). There was no statistically significant difference in the length of hospital stay,fracture healing time,palm tilt angle,ulnar angle or radius height of the two groups( P > 0. 05). There was no significant difference in Gartlant-Werley score or the excellent and good rate between the two groups( P >0. 05). Conclusion The healing of ulnar styloid process may not be affected in the short term on the rehabilitation of wrist joint after distal radius fracture fixation.
引文
[1] Daneshvar P,Chan R,Macdermid J,et al. The effects of ulnar styloid fractures on patients sustaining distal radius fractures[J]. J Hand Surg Am,2014,39(10):1915-1920.
[2]沈伟华.手术治疗右肘腕关节复杂损伤病例1则[J/CD].中华关节外科杂志(电子版),2018,12(1):110-114.
[3] Gong HS,Cho HE,Kim J,et al. Surgical treatment of acute distal radioulnar joint instability associated with distal radius fractures[J]. J Hand Surg Eur Vol,2015,40(8):783-789.
[4] Fullilove S,Gozzard C. Dorsally displaced fractures of the distal radius:a critical appraisal of the DRAFFT(distal radius acute fracture fixation trial)study[J]. Bone Joint J,2016,98B(3):298-300.
[5] Yilmaz S,Cankaya D,Karakus D. Ulnar styloid fracture has no impact on the outcome but decreases supination strength after conservative treatment of distal radial fracture[J]. J Hand Surg Eur Vol,2015,40(8):872-873.
[6]简小飞,陈廖斌,王华.尺骨茎突骨折及分型对复杂桡骨远端骨折钢板内固定术后疗效的影响[J].中华创伤骨科杂志,2014,16(10):918-920.
[7]张超,谢雪涛,胡顺东,等.尺骨茎突骨折对桡骨远端骨折内固定术后腕关节功能的影响[J].国际骨科学杂志,2016,18(4):264-266.
[8]鲍飞龙,刘涛,胡义明,等.桡骨远端乙状切迹背侧骨块不同治疗对腕关节功能恢复的探讨[J/CD].中华关节外科杂志(电子版),2013,7(5):673-678.
[2]沈伟华.手术治疗右肘腕关节复杂损伤病例1则[J/CD].中华关节外科杂志(电子版),2018,12(1):110-114.
[3] Gong HS,Cho HE,Kim J,et al. Surgical treatment of acute distal radioulnar joint instability associated with distal radius fractures[J]. J Hand Surg Eur Vol,2015,40(8):783-789.
[4] Fullilove S,Gozzard C. Dorsally displaced fractures of the distal radius:a critical appraisal of the DRAFFT(distal radius acute fracture fixation trial)study[J]. Bone Joint J,2016,98B(3):298-300.
[5] Yilmaz S,Cankaya D,Karakus D. Ulnar styloid fracture has no impact on the outcome but decreases supination strength after conservative treatment of distal radial fracture[J]. J Hand Surg Eur Vol,2015,40(8):872-873.
[6]简小飞,陈廖斌,王华.尺骨茎突骨折及分型对复杂桡骨远端骨折钢板内固定术后疗效的影响[J].中华创伤骨科杂志,2014,16(10):918-920.
[7]张超,谢雪涛,胡顺东,等.尺骨茎突骨折对桡骨远端骨折内固定术后腕关节功能的影响[J].国际骨科学杂志,2016,18(4):264-266.
[8]鲍飞龙,刘涛,胡义明,等.桡骨远端乙状切迹背侧骨块不同治疗对腕关节功能恢复的探讨[J/CD].中华关节外科杂志(电子版),2013,7(5):673-678.