尺骨茎突骨折合并尺神经手背支腕关节支损伤临床研究

CLINICAL RESEARCH OF ULNAR STYLOID FRACTURE COMPLICATED WITH WRIST DORSAL BRANCH OF ULNAR NERVE INJURY

目的总结尺骨茎突骨折合并尺神经手背支腕关节支损伤的治疗方法及疗效。方法 2005年10月-2012年10月,收治16例尺骨茎突骨折合并尺神经手背支腕关节支损伤患者。其中男14例,女2例;年龄22～58岁,平均42岁。致伤原因:交通事故伤8例,机械绞伤5例,摔伤3例。根据尺骨茎突解剖特点及影像学表现,将尺骨茎突骨折分为两型:Ⅰ型(尺骨茎突尖端骨折)1例,Ⅱ型(尺骨茎突基底部骨折)15例。腕尺侧皮肤感觉功能根据英国医学研究会1954年制定的手感觉功能评定标准评定:S05例,S11例,S27例,S33例。受伤至手术时间6～72 h,平均18 h。对尺骨茎突骨折行内固定;同时探查尺神经手背支腕关节支,根据损伤程度对神经进行修复,其中13例挫伤者行神经外膜松解减压,3例完全断裂者取腓肠神经移植修复。结果术后切口均Ⅰ期愈合。16例均获随访,随访时间6～24个月,平均14个月。X线片示尺骨茎突骨折均骨性愈合,愈合时间4～10周,平均6周。患者均未出现腕尺侧慢性疼痛及腕部不能用力旋转等表现。末次随访时,腕关节功能采用Green-O’Brien评分法评定,获优13例,良3例;腕尺侧皮肤感觉功能根据英国医学研究会1954年制定的手感觉功能评定标准均为优,其中S411例、S3+5例;腕尺侧两点辨别觉为5～9 mm,平均6.6 mm。结论对于尺骨茎突骨折合并尺神经手背支腕关节支损伤,骨折行内固定治疗,同时探查修复神经损伤,可预防腕尺侧慢性疼痛,恢复腕尺侧感觉功能。

Objective To analyze the therapy and effectiveness of ulnar styloid fracture complicated with wrist dorsal branch of ulnar nerve injury. Methods Between October 2005 and October 2012, 16 cases of ulnar styloid fracture complicated with wrist dorsal branch of ulnar nerve injury were treated. There were 14 males and 2 females with an average age of 42 years （range, 22-58 years）. Fracture was caused by traffic accident in 8 cases, by mechanical crush in 5 cases, and by falling in 3 cases. According to the anatomical features of the ulnar styloid and imaging findings, ulnar styloid fractures were classified as type I （ulnar styloid tip fracture） in 1 case and type II （ulnar styloid base fracture） in 15 cases. The skin sensation of ulnar wrist was So in 5 cases, S1 in 1 case, S2 in 7 cases, and S3 in 3 cases according to the criteria of the British Medical Research Council in 1954 for the sensory functions of the ulnar wrist. The time from injury to operation was 6-72 hours （mean, 18 hours）. Fracture was treated by operative fixation, and nerve was repaired by epineurium neurolysis in 13 cases of nerve contusion and by sural nerve graft in 3 cases of complete nerve rupture. Results All incisions healed by first intention. Sixteen patients were followed up for an average time of 14 months （range, 6-24 months）. The X-ray films showed that all of them achieved bone union at 4-10 weeks after operation （mean, 6 weeks）. No patient had complications such as ulnar wrist chronic pain and an inability to rotate. According to Green-O＇Brien wrist scoring system, the results were excellent in 13 cases and good in 3 cases; according to the criteria of the British Medical Research Council in 1954 for the sensory functions of the ulnar wrist, the results were excellent in all cases, including 11 cases ofS4 and 5 cases of S3＋. Two-point discrimination of the ulnar wrist was 5-9 mm （mean, 6.6 ram）. Conclusion For patients with ulnar styloid fracture complicated with wrist dorsal branch of ulnar nerve injury, internal fixation and nerve repair should be performed. It can prevent ulnar wrist pain and promote sensory recovery.