桡骨远端骨折合并腕骨骨折的诊断与治疗

Diagnosis and treatment of distal radius fractures with concomitant carpal fractures

目的 研究分析桡骨远端骨折合并各类腕骨骨折的发生率和相关危险因素,探讨治疗方法的选择.方法 回顾2010年1月至2012年1月共204例桡骨远端骨折患者,行腕部正、侧位X线检查,部分病例行CT平扫及重建.从中统计合并单块或多块腕骨骨折的病例,统计桡骨远端骨折合并腕骨骨折的发生率,分析相关危险因素,并根据中华医学会手外科学会腕关节功能评定标准评价不同治疗方式的选择及疗效.结果 共有15例（7.35％）桡骨远端骨折患者合并发生腕骨骨折,其中合并舟状骨骨折8例（发生率最高）,三角骨骨折2例,头状骨骨折1例,月骨骨折1例,钩骨骨折1例,有2例合并至少两处腕骨骨折.共有8例无法通过常规X线发现腕骨骨折,而是需要CT平扫得以明确.各相关危险因素中,以男性患者、AO分型为B型、致伤原因为高能量损伤的患者容易发生桡骨远端骨折合并腕骨骨折.治疗方式包括骨折切开复位内固定以及石膏外固定,平均骨折愈合时间为4个月,有3例发生腕骨骨折延迟愈合.所有患者经明确诊断和治疗后,腕关节功能均有显著改善.结论 桡骨远端骨折合并腕骨骨折发生率不高,很容易被忽视造成漏诊,CT检查可以显著提高诊断效率.男性患者,骨折类型为B型和高能量损伤是合并腕骨骨折的高危因素.无明显移位的骨折需延长石膏外固定时间和开始功能锻炼时间,而移位明显的腕骨骨折则需要切开复位内固定以纠正移位.

Objective To investigate the incidence and the risk factors of carpal fractures occurring concurrently with distal radius fractures and to explore the treatment options for these concomitant fractures.Methods A retrospectively analysis was carried out of 204 cases of distal radius fractures treated from January 2010 to January 2012.Posteroanterior and lateral radiographs of the wrist were examined,as were computed tomography scans when available.Cases with concomitant single or multiple carpal fractures were identified.The incidence of these concomitant fractures was calculated.AO classification and the energy of injury of these cases were analyzed to identify the risk factors.The clinical outcomes of various treatment options were assessed using the wrist function evaluation criteria issued by Hand Surgery Society of the Chinese Medical Association.Results A total of 15 cases of the 204 distal radius fractures （7.35%） had concomitant carpal fractures.Of these fractures,8 involved scaphoid,2 involved triquetrum,1 involved capitate,1 involved lunate,1 involved hamate and 2 involved more than one carpal bones.Plain wrist X-rays missed 8 of these carpal fractures which were diagnosed by computed tomography scans.Risk factor analysis revealed that male patients,AO type B distal radius fractures and high-energy injuries more likely led to concomitant fractures of both the distal radius and carpals.Treatment options included open reduction and internal fixation （ORIF） or closed reduction and cast immobilization.The average bone healing time was 4 months.Delayed union of carpal fractures was seen in 3 cases.Wrist function was markedly improved after the treatment in all the cases.Conclusion The incidence of carpal fractures occurring concurrently with distal radius fractures is low.Diagnosis can be missed if neglected.Computed tomography should be considered to increase the rate of correct diagnosis.Male patients,AO type B distal radius fractures and high-energy injuries are significant risk factors.For carpal fractures without displacement,extending cast immobilization and postponing functional rehabilitation should be the treatment option.When there is obvious displacement of carpal fractures,ORIF is an effective treatment method to correct the displacement.