尺骨茎突基底部骨折微型螺钉固定与非固定治疗效果比较
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摘要
目的比较尺骨茎突基底部骨折(HauckⅡ型)经微型螺钉固定与非固定治疗的疗效。方法选取作者医院收治的95例HauckⅡ型尺骨茎突骨折患者,其中采用微型螺钉固定43例(44处),非固定组52例(55处)。随访两组患者尺骨茎突骨折愈合情况,并采用AO组织Gartland-Werley评分标准和Nakamura法对患者进行疗效比较。结果术后所有患者均获得随访,时间10～26个月,平均16.4个月。微型螺钉固定组愈合率为100%,愈合时间5～13(9.80±3.70)周,术后随访中无螺钉松动或断裂、切口感染、畸形愈合或不愈合,优良率为93.18%。非固定组愈合率为61.82%,愈合用时间为5～16(10.40±4.20)周,优良率为63.64%。12例患者出现畸形愈合,6例患者残留腕尺侧旋转疼痛。两组在愈合率、优良率比较差异具有统计学意义(P<0.01)。末次随访时微型螺钉固定组出现桡尺远侧关节松弛比例明显低于非固定组(11.36%vs. 56.36%)。结论微型螺钉是治疗HauckⅡ型尺骨茎突骨折安全有效的方法,在骨折愈合率和功能恢复方面明显优于非手术治疗。
Objective To compare the efficacy of micro-screw fixation and non-fixation treatment for Hauck type Ⅱ ulnar styloid fracture. Methods A total of 95 patients with Hauck type Ⅱ ulnar styloid fractures in authors′ hospital were enrolled,43 cases(44 sides) were fixed with micro-screws and 52 cases(55 sides) with non-fixation.The prognosis of ulnar styloid fractures was followed up in the two groups,and the effects were compared using the AO tissue Gartland-Werley score and the Nakamura method. Results All patients were followed up for 10 to 26 months with an average of 16.4 months.The micro-screw fixation group had a healing rate of 100%,a healing time of 5 to 13 weeks, and an average of(9.80±3.70) weeks.There were no screw loosening or rupture,incision infection,malunion or non-union in the follow-up,the overall satisfactory rate was 93.18%.The healing rate in non-fixed group was 61.82%,and the healing time was 5 to 16 weeks,with an average of(10.40±4.20) weeks,the overall satisfactory rate was 63.64%.Malunion occurred in 12 patients,and residual ulnar rotation pain in 6 patients.There were significantly different in healing rate and overall satisfactory rate between two groups(P<0.01). At the last follow-up, the proportion of distal joint relaxation in the micro-screw fixation group was significantly lower than that in the non-fixed group(11.36% vs. 56.36%). Conclusion Micro-screw is a safe and effective method for the treatment of Hauck type Ⅱ ulnar styloid fracture.It is superior to non-surgical treatment on fracture healing rate and functional recovery.
Objective To compare the efficacy of micro-screw fixation and non-fixation treatment for Hauck type Ⅱ ulnar styloid fracture. Methods A total of 95 patients with Hauck type Ⅱ ulnar styloid fractures in authors′ hospital were enrolled,43 cases(44 sides) were fixed with micro-screws and 52 cases(55 sides) with non-fixation.The prognosis of ulnar styloid fractures was followed up in the two groups,and the effects were compared using the AO tissue Gartland-Werley score and the Nakamura method. Results All patients were followed up for 10 to 26 months with an average of 16.4 months.The micro-screw fixation group had a healing rate of 100%,a healing time of 5 to 13 weeks, and an average of(9.80±3.70) weeks.There were no screw loosening or rupture,incision infection,malunion or non-union in the follow-up,the overall satisfactory rate was 93.18%.The healing rate in non-fixed group was 61.82%,and the healing time was 5 to 16 weeks,with an average of(10.40±4.20) weeks,the overall satisfactory rate was 63.64%.Malunion occurred in 12 patients,and residual ulnar rotation pain in 6 patients.There were significantly different in healing rate and overall satisfactory rate between two groups(P<0.01). At the last follow-up, the proportion of distal joint relaxation in the micro-screw fixation group was significantly lower than that in the non-fixed group(11.36% vs. 56.36%). Conclusion Micro-screw is a safe and effective method for the treatment of Hauck type Ⅱ ulnar styloid fracture.It is superior to non-surgical treatment on fracture healing rate and functional recovery.
引文
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[11] 李春汪,王保苍,王斌.带孔克氏针张力带技术治疗尺骨茎突骨折[J].中华手外科杂志,2016,32(6):412-413
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[13] 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
[14] 李治,马骥,张洋,等.无头加压空心螺钉用于桡骨远端骨折内固定术效果观察[J].山东医药,2012,52(35):65-66
[15] 米琨,刘鹏飞,刘武,等.腕关节镜下治疗尺骨茎突骨折[J].中华手外科杂志,2010,26(5):288-290
[16] Almedghio S,Arshad MS,Almari F,et al.Effects of ulnar styloid fractures on unstable distal radius fracture outcomes:a systematic review of comparative studies[J].J Wrist Surg,2017,7(2):172-181
[2] 李永耀,程灏,赵勇,等.夹板固定治疗尺骨茎突骨折的三维有限元分析[J].中国组织工程研究,2018,22(11):1737-1742
[3] 黄继锋,钟世镇.桡尺远侧关节稳定结构的生物力学分析[J].中华手外科杂志,2001,17(2):125-127
[4] 徐吉海,王欣,陈宏,等.累及桡尺远侧关节不稳定的尺骨茎突骨折手术治疗[J].中华手外科杂志,2011,27(6):341-342
[5] 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
[6] 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
[7] 杨焕友,王斌,李浩,等.尺骨茎突骨折手术与非手术治疗的疗效比较研究[J].中华手外科杂志,2011,27(1):13-15
[8] Reichl M,Piatek S,Adolf D,et al.Unrepaired fracture of the styloid process of the ulna:not a bad treatment result at distal radius fracture[J].Unfallchirurg,2011,114(12):1099-1104
[9] 赵亮,王宝军,李亚东,等.尺骨茎突骨折及分型对桡骨远端骨折术后临床疗效的随访研究[J].北京大学学报(医学版),2011,8(5):675-680
[10] 周强,陆骅,王占朝,等.生物可吸收张力带治疗尺骨茎突骨折的评价[J].中国组织工程研究,2013,17(25):4733-4738
[11] 李春汪,王保苍,王斌.带孔克氏针张力带技术治疗尺骨茎突骨折[J].中华手外科杂志,2016,32(6):412-413
[12] Sawada H,Shinohara T,Natsume T,et al.Clinical effects of internal fixation for ulnar styloid fractures associated with distal radius fractures:a matched case-control study[J].J Orthop Sci,2016,21(6):745-748
[13] 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
[14] 李治,马骥,张洋,等.无头加压空心螺钉用于桡骨远端骨折内固定术效果观察[J].山东医药,2012,52(35):65-66
[15] 米琨,刘鹏飞,刘武,等.腕关节镜下治疗尺骨茎突骨折[J].中华手外科杂志,2010,26(5):288-290
[16] Almedghio S,Arshad MS,Almari F,et al.Effects of ulnar styloid fractures on unstable distal radius fracture outcomes:a systematic review of comparative studies[J].J Wrist Surg,2017,7(2):172-181