腕关节镜下治疗尺骨茎突骨折

Wrist arthroscopic treatment for fractures of the ulna styloid process

目的 探讨腕关节镜监视下治疗尺骨茎突骨折的方法,以获得更好的治疗效果.方法 对15例尺骨茎突骨折的患者,在C臂透视机及腕关节镜监视下先将合并的桡骨远端骨折进行复位,经皮穿针内固定或切开复位钢板内固定,然后在腕关节镜下检查三角纤维软骨复合体（triangular fibrocartilage complex,TFCC）是否损伤,并作修整、清理等相应的处理,在关节镜监视下将尺骨茎突骨折复位,经皮作钢丝张力带内固定.结果 11例合并有TFCC损伤,经平均15.4个月的临床随访,X线片检查显示尺骨茎突骨折全部骨性愈合,骨性愈合时间平均5.2个月.按照Green-O＇Brien功能评定方法进行腕关节功能评定,优良率为93.3%,无腕关节尺侧疼痛及腕关节不稳等并发症发生.结论 腕关节镜下治疗尺骨茎突骨折既可以对骨折进行有效的复位及固定,有利于骨折的愈合;又可以了解腕关节内TFCC等结构的损伤程度,便于早期处理,以免遗留慢性腕痛或腕关节不稳定.

Objective To discuss the treatment methods of wrist arthroscopic management for fractures of the ulna styloid process to achieve better clinical outcomes. Methods Fifteen cases of fractures of the ulna styloid process were first treated with reduction of combined fracture of the distal radius under C-arm fluoroscope and wrist arthroscope monitoring using percutaneous pinning fixation or open reduction and internal fixation with plate and screws. The triangular fibrocartilage complex （TFCC） was examined under wrist arthroscope and debridement or repair was done accordingly. The fractured ulna styloid process was reduced and fixed with steel tension band under wrist arthroscope monitoring. Results Eleven cases had concomitant TFCC injury. The patients were follow-up for an average of 15.4 months and the X-ray showed bone union of all the ulna styloid process fractures. The mean healing time was 5.2 months. According to the Green-O＇ Brien functional evaluation criteria the excellent and good rate of wrist function was 93.3%. There were no complications such as ulnar side pain and wrist instability. Conclusion Wrist arthroscopic treatment of fractures of ulna styloid process is not only effective to reduce and fix the fracture and beneficial for fracture heeling, but also able to detect TFCC injury for early management to avoid chronic wrist pain or wrist instability.