桡骨远端骨折与腕关节不稳的临床研究

A clinical study of distal radial fractures and carpal instability

目的研究桡骨远端骨折保守和手术治疗后腕关节不稳的转归及关节不稳对功能的影响。方法1999年1月～2004年3月,临床随访124例采用石膏、外固定支架和桡骨远端钢板固定治疗的桡骨远端骨折患者,根据X线片测量判断治疗前、后腕关节不稳的变化,Gartland与Werley评分标准评定腕关节功能恢复情况。结果随访中发现有背侧偏移、掌侧偏移、背屈不稳(DISI)、掌屈不稳(VISI)和舟月分离五种腕关节不稳;治疗前、后和随访时腕关节不稳发生率分别为58.1%、21.8%和22.6%;优良率为80.6%,稳定组和不稳定组优良率分别为84.5%和75.0%。结论桡骨远端骨折后常可合并不同类型的腕关节不稳,手术治疗可以有效纠正桡腕关节不稳,舟月分离性腕关节不稳很难被纠正,腕关节不稳定组的腕关节功能明显比腕关节稳定组差,桡腕关节的完整性是影响腕关节功能的主要因素。

Objective To investigate carpal instability after distal radial fractures have been treated with cast immobilization or operation and its effect on clinical functions. Methods 124 patients with distal radial fracture were treated with cast immobilization, external fixation or plate internal fixation. They were followed up. Their carpal instability was evaluated according to X-ray manifestations before and after treatment; their clinical carpal functions were assessed according to Gartland and Werley scoring system. Results The follow-ups revealed five types of carpal instability： palmar or dorsal shift of the carpus, VISI （volar intercalated segment instability）, DISI （dorsal intercalated segment instability） and scapholunate dissociation. The incidence of carpal instability was 58. 1% before treatment, 21.8% after treatment and 22.6% at the follow-ups. Functional results were excellent and good in 80. 6 % of the total patients, in 84. 5% of those in the stability group, and in 75.0% of those in the instability group. Conclusions Distal radial fractures usually lead to carpal instability. Operations can correct radius-carpal instability effectively, but it is difficult to correct scapholunate dissociation. The function of carpal joint is evidently poorer in patients with carpal instability than in those with carpal stability, for it is mainly affected by the integrality of radius-carpal joint.