摘要
目的:探讨是否合并尺骨茎突骨折、骨折分型及愈合情况会影响桡骨远端骨折手术治疗疗效。方法:收集自2007年1月至2010年10月因桡骨远端不稳定骨折于北京友谊医院接受内固定手术治疗且具有完整随访资料的病例52例,均行切开复位锁定钢板螺钉内固定手术,尺骨茎突骨折均未予固定。记录病例AO分型及术前、术后3个月和术后1年的X线测量结果(掌倾角、尺偏角、桡骨茎突高度)及Gartlant-Werley评分。将所有资料按照尺骨茎突骨折合并组与未合并组、茎突骨折Ⅰ型组及Ⅱ型组、茎突骨折愈合组及未愈合组分组进行整理分析。结果:随访时间6～34个月,平均15个月,52例桡骨骨折均愈合。尺骨茎突骨折合并组与未合并组术前尺偏角、桡骨茎突高度差异有统计学意义,但术后3个月、术后1年两组掌倾角、尺偏角、桡骨茎突高度及平均Gartlant-Werley评分、优良率差异无统计学意义,总优良率81%。尺骨茎突骨折合并组中,茎突骨折Ⅰ型组及Ⅱ型组相比,茎突骨折愈合组与非愈合组相比,术前、术后3个月及术后1年掌倾角、尺偏角、桡骨高度差异均无统计学意义,且术后3个月及术后1年的Gartlant-Werley评分、优良率差异亦无统计学意义。术后6例并发症,合并组4例,未合并组2例,并发症11%。螺钉切入关节并创伤性关节炎1例,异位骨化1例,皮神经损伤2例,术后内固定拔退出并骨折畸形愈合1例,创伤性关节炎伴关节僵硬1例,组间并发症发生率无明显差别。结论:切开复位锁定钢板螺钉内固定治疗桡骨远端骨折,能够有效维持骨折及关节面复位,其术后疗效满意、肯定。是否合并尺骨茎突骨折、茎突骨折愈合与否及其骨折分型,对术后X线测量及腕关节功能无影响,其中长期疗效仍需进一步观察。
Objective：To analyze the result of the distal radial fractures with or without ulnar styloid fracture.Methods： From January 2007 to October 2010,62 cases with distal radial fractures were treated by ORIF,of which 52 were followed-up entirely with an average of 15 months（6-34 months）,including 6 male cases and 46 female cases at an average age of（62.25±8.25） years.All ulnar styloid fractures were not fixed.According to ulnar styloid fractures,all cases were divided into two groups,group A（32 cases with ulnar styloid fractures） and group B（20 cases without）.Group A was further divided into type Ⅰ（tip fracture of ulnar styloid,12 cases） and type Ⅱ（base fracture of ulnar styloid,20 cases）.AO classification,volar tilt,radial inclination and radial height were recorded before and after operation.Complications and Garlant-Werley Scores were evaluated 3 months and 1 year after operation.Results： All distal radial fractures were union in 8 weeks to 12 weeks.There were significant differences in radial inclination and radial process height,but not in volar tilt between groups A and B before operation.We found no significant differences in volar tilt,radial inclination,radial process height and Garlant-Werley scores between groups A and B 3 months and 1 year after operation.There were also no significant differences between typeⅠand typeⅡ.Fineness was 81%.Complications were found in 6 cases（4 in group A and 2 in group B）,in which there were 1 case with a screw cutting-off and traumatic arthritis,2 cases with sup-nerve injury and 1 case with heterotopic ossification,1 case of malunion,and 1 case with wrist stiffness and traumatic arthritis.Conclusion： ORIF with locking plate in distal radial fracture is safe and effective.There is no significant difference between the outcomes of patients with and without ulnar styloid fractures,also in patients with type Ⅰ and type Ⅱ fractures,union or nonunion of fractures,according to the X-ray measurement and Garlant-Werley wrist function scores.However,long-term following-up is still needed.
出处
《北京大学学报（医学版）》
CAS
CSCD
北大核心
2011年第5期675-680,共6页
Journal of Peking University:Health Sciences
关键词
桡骨骨折
尺骨骨折
腕关节
治疗结果
Radius fractures
Ulna fractures
Carpal joints
Treatment outcome
