切开复位克氏针张力带内固定治疗Hauck Ⅱ型尺骨茎突骨折

Open reduction and internal fixation with Kirschner wire and tension band for treatment of Hauck typeⅡulnar styloid fractures

目的:探讨切开复位克氏针张力带内固定治疗Hauck Ⅱ型尺骨茎突骨折的临床疗效和安全性。方法:对2015年1月至2018年6月采用切开复位克氏针张力带内固定治疗和未作处理的132例Hauck Ⅱ型尺骨茎突骨折患者的病例资料进行回顾性对比分析。男60例,女72例;年龄24~78岁,中位数48岁;均合并桡骨远端骨折;受伤至手术时间3~12 d,中位数5 d。桡骨远端骨折均采用切开复位钢板内固定治疗,尺骨茎突骨折采用切开复位克氏针张力带内固定治疗或不作处理。分析骨折愈合、腕关节旋转疼痛缓解、腕关节功能恢复及并发症发生情况。结果:132例患者,尺骨茎突骨折采用切开复位克氏针张力带内固定治疗58例(克氏针张力带组),尺骨茎突骨折未作处理74例(未处理组)。患者均获随访,随访时间12~36个月,中位数16个月。切口均甲级愈合;桡骨远端骨折均骨性愈合,愈合时间3~6个月,中位数4个月。术后12个月时,克氏针张力带组尺骨茎突骨折愈合53例,患腕旋转无痛40例,腕关节Mayo评分(90.47±5.35)分,腕关节功能评价优28例、良26例、可4例;未处理组尺骨茎突骨折愈合48例,患腕旋转无痛28例,腕关节Mayo评分(85.22±7.92)分,腕关节功能评价优26例、良34例、可12例、差2例;克氏针张力带组尺骨茎突骨折愈合率、患腕旋转疼痛缓解率、腕关节Mayo评分均高于未处理组(χ^2=12.721,P=0.000;χ^2=11.555,P=0.001;t=4.331,P=0.000),腕关节功能评价结果优于未处理组(Z=-1.900,P=0.047)。克氏针张力带组发生克氏针退针3例,未出现腕关节旋转疼痛症状,未行特殊处理;均未发生切口感染、螺钉松动、骨折复位丢失及神经、血管损伤等并发症。结论:切开复位克氏针张力带内固定治疗Hauck Ⅱ型尺骨茎突骨折,并发症少,与不作处理比较,更有利于骨折愈合、患腕疼痛缓解及腕关节功能的恢复。

Objective:To explore the clinical curative effects and the safety of open reduction and internal fixation with Kirschner wire and tension band for treatment of Hauck type Ⅱ ulnar styloid fractures.Methods:The medical records of 132 patients with Hauck type Ⅱ ulnar styloid fractures who were untreated with any therapy or treated with open reduction and internal fixation with Kirschner wire and tension band from January 2015 to June 2018 were analyzed retrospectively.The patients consisted of 60 males and 72 females and ranged in age from 24 to 78 years(Median=48 yrs)and ranged in disease course from 3 to 12 days(Median=5 days).All of the 132 patients were diagnosed as ulnar styloid fracture combined with distal radius fracture.The distal radius fractures were treated with open reduction and plate internal fixation,while the ulnar styloid fractures were untreated or treated with open reduction and internal fixation with Kirschner wire and tension band.The fracture healing,wrist rotation pain relief,wrist function recovery and complications were analyzed respectively.Results:Fifty-eight out of 132 patients with ulnar styloid fractures were treated with open reduction and internal fixation with Kirschner wire and tension band(Kirschner wire and tension band group),while the other 74 patients were untreated with any therapy(non-treatment group).All patients in the 2 groups were followed up for 12-36 months with a median of 16 months.All patients got primary operative incision healing and bone union of distal radius fractures.The distal radius fracture healing time ranged from 3 to 6 months with a median of 4 months.At 12 months after the treatment,the ulnar styloid fracture healed in 53 patients in Kirschner wire and tension band group and 48 patients in non-treatment group,and painless rotation of wrist was found in 40 patients in Kirschner wire and tension band group and 28 patients in non-treatment group.The Mayo wrist scores were 90.47+/-5.35 points in Kirschner wire and tension band group and 85.22+/-7.92 points in non-treatment group.The wrist function evaluation results showed that 28 patients obtained an excellent result,26 good and 4 fair in Kirschner wire and tension band group;while 26 patients obtained an excellent result,34 good,12 fair and 2 poor in non-treatment group.The ulnar styloid fracture healing rate,affected wrist rotation pain relief rate and Mayo wrist scores were higher in Kirschner wire and tension band group compared to non-treatment group(χ^2=12.721,P=0.000;χ^2=11.555,P=0.001;t=4.331,P=0.000),and Kirschner wire and tension band group surpassed non-treatment group in the function evaluation results of affected wrist(Z=-1.900,P=0.047).The Kirschner wire withdrawal was found in 3 patients in Kirschner wire and tension band group,and no rotation pain were found in wrists,so no special treatment was performed.No complications such as incision infection,screw loosening,fracture reduction loss and damage of nerve or blood vessel were found in the 2 groups.Conclusion:Open reduction and internal fixation with Kirschner wire and tension band is more conducive to fracture healing,affected wrist pain relief and function recovery with less complications in treatment of Hauck type Ⅱ ulnar styloid fractures as compared with non-treatment.