中国组织工程研究 ›› 2023, Vol. 27 ›› Issue (36): 5840-5844.doi: 10.12307/2023.735

• 骨科植入物 orthopedic implant • 上一篇    下一篇

尺骨茎突基底部骨折内固定对腕关节功能的影响

成  帅,江善勇,卢建树,吉旭彬   

  1. 东营市人民医院创伤骨科,山东省东营市   257000
  • 收稿日期:2022-09-14 接受日期:2022-11-30 出版日期:2023-12-28 发布日期:2023-03-25
  • 通讯作者: 吉旭彬,副主任医师,东营市人民医院创伤骨科,山东省东营市 257000
  • 作者简介:成帅,男,1987年生,汉族, 2013年滨州医学院毕业,硕士,主治医师,主要从事骨外科临床工作。

Effect of internal fixation of ulnar styloid process base fracture on wrist function

Cheng Shuai, Jiang Shanyong, Lu Jianshu, Ji Xubin   

  1. Department of Trauma and Orthopedics, Dongying People’s Hospital, Dongying 257000, Shandong Province, China
  • Received:2022-09-14 Accepted:2022-11-30 Online:2023-12-28 Published:2023-03-25
  • Contact: Ji Xubin, Associate chief physician, Department of Trauma and Orthopedics, Dongying People’s Hospital, Dongying 257000, Shandong Province, China
  • About author:Cheng Shuai, Master, Attending physician, Department of Trauma and Orthopedics, Dongying People’s Hospital, Dongying 257000, Shandong Province, China

摘要:


文题释义:

三角纤维软骨复合体:是指腕关节尺侧的一组重要结构,它包括纤维软骨关节盘、半月板同系物、掌侧和背侧远尺桡韧带、尺侧伸腕肌腱深层、尺侧关节囊、尺月韧带和尺三角韧带。
远尺桡关节稳定结构:包括外在稳定结构的尺侧屈腕肌腱、第 6 伸肌间室、旋前方肌浅头和深头、前臂骨间膜以及内在稳定结构的关节盘、掌侧和背侧远尺桡韧带。

背景:桡骨远端骨折合并尺骨茎突基底部骨折在临床中常见,因其骨折及周围韧带、软骨组织的双重破坏,导致桡尺远侧关节不稳定。以往对尺骨茎突基底部骨折不够重视,往往会出现手术后腕关节疼痛、活动范围受限等并发症的发生,治疗方案存在争议。
目的:探讨桡骨远端骨折术中一期行尺骨茎突基底部骨折内固定对腕关节功能恢复的影响。
方法:回顾性分析东营市人民医院在2018年6月至2020年12月收治的创伤致桡骨远端合并尺骨茎突基底部骨折并行手术治疗患者40例,桡骨远端骨折治疗方式均为行切开复位内固定。根据在桡骨手术完成后是否行尺骨茎突基底部内固定,将患者分为内固定组和对照组,每组20例。收集患者术前及术后6,12个月随访X射线片测量数据,比较两组患者的尺偏角、掌倾角及桡骨高度;术后1年记录腕关节背伸、掌屈、桡偏、尺偏、旋前、旋后方向的活动范围,应用加特兰德-韦利(Gartland-Werley)评分标准评定疗效。
结果与结论:术后随访时,两组患者所测量的腕关节掌倾角、尺偏角、桡骨高度均优于术前(P < 0.05),但两组间比较差异无显著性意义

(P > 0.05);术后1年内固定组腕关节背伸、掌屈、桡偏、尺偏、旋前、旋后方向的活动范围均优于对照组(P < 0.05);术后1年内固定组疗效优良率90%,明显高于对照组55%(P < 0.05)。结果表明,桡骨远端骨折术中一期行尺骨茎突基底部骨折内固定有利于进一步恢复腕关节功能。

https://orcid.org/0000-0003-3946-8084 (成帅) 

中国组织工程研究杂志出版内容重点:人工关节;骨植入物;脊柱;骨折;内固定;数字化骨科;组织工程

关键词: 尺骨茎突基底部骨折, 桡骨远端骨折, 腕关节功能, 治疗结果, 桡尺远侧关节, 三角纤维软骨复合体

Abstract: BACKGROUND: Fractures of the distal radius and the base of the styloid process of the ulna are common in clinical practice. Because of the double destruction of the fracture and the surrounding ligaments and cartilage, the distal radioulnar joint is unstable. In the past, insufficient attention was paid to the fracture of the base of the styloid process of the ulna, which often led to complications such as wrist joint pain and limited range of motion after surgery, and the treatment plan was controversial.  
OBJECTIVE: To investigate the effect of internal fixation on the function of the wrist joint with fracture of ulnar styloid process base in distal radius fracture.
METHODS: Clinical data of 40 patients with traumatic distal radius fractures accompanied by ulnar styloid process base fractures treated with concurrent surgical treatment in Dongying People’s Hospital from June 2018 to December 2020 were retrospectively analyzed. All distal radius fractures were operated by open reduction and internal fixation. According to whether the fracture of the base of ulnar styloid process was treated surgically or not, the patients were divided into the internal fixation group and control group, with 20 cases in each group. The measured data of X-ray films were collected before and 6 and 12 months after operation, and the ulnar inclination, palmar tilt and radial height of the two groups were compared. The ranges of motion of the wrist joint in dorsal extension, palmar flexion, radial deviation, ulnar deviation, pronation and supination directions were recorded 1 year after operation. The effect was evaluated with the Gartland-Werley scoring standard.  
RESULTS AND CONCLUSION: At the follow-up after operation, palmar tilt, ulnar inclination and radial height of the wrist joint of the two groups were all better than those before operation (P < 0.05), but the difference was not statistically significant between the two groups (P > 0.05). The ranges of motion of the wrist joint in dorsal extension, palmar flexion, radial deviation, ulnar deviation, pronation and supination directions were better in the internal fixation group than those in the control group 1 year after operation (P < 0.05). The excellent and good rate of the internal fixation group (90%) 1 year after the operation was significantly higher than that of the control group (55%) (P < 0.05). These findings conclude that one-stage internal fixation of ulnar styloid process base fracture during the operation of distal radius fracture is conducive to further recovery of wrist function.

Key words: ulnar styloid process base fracture, distal radius fracture, wrist joint function, therapeutic result, distal radioulnar joint, triangular fibrocartilage complex

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