桡骨远端骨折桡侧移位对桡尺远侧关节稳定性的影响

The influence of radial displacement in distal radius fracture on the stability of distal radioulnar joint

目的探讨桡骨远端骨折移位造成桡尺远侧关节不稳的原因,分析桡骨远端骨折桡侧移位程度对腕关节稳定性的重要性。方法60例桡骨远端骨折患者,男22例,女38例;年龄26?67岁,平均41岁。伴尺骨茎突骨折29例,不伴尺骨茎突骨折31例。均为桡骨远端骨折块向桡侧移位,根据移位程度分三组:13例移位小于2 mm,20例大于2 mm、小于4 mm以及27例大于4 mm,均采用桡骨远端骨折掌侧切开复位钢板内固定术,术中放置钢板固定骨折后检查桡尺远侧关节稳定性。将术中物理检查桡尺远侧关节不稳定的15例患者(伴尺骨茎突骨折)分为两组,一组术中使用钢丝“8”字固定尺骨茎突,另一组不固定。分析桡骨远端骨折后桡侧移位程度对尺骨茎突的影响以及合并尺骨茎突骨折者对桡尺远侧关节稳定性的影响。随访掌倾角、尺偏角及腕关节功能评分来评价桡骨远端骨折桡侧移位程度及是否合并尺骨茎突骨折对桡尺远侧关节稳定性的影响。结果桡骨远端骨折桡侧移位大于4 mm时损伤TFCC是造成桡尺远侧关节不稳、影响腕部功能的主要原因。桡骨远端骨折是否伴有尺骨茎突骨折对桡尺远侧关节不稳发生率比较差异有统计学意义。桡骨远端骨折桡侧移位大于4 mm与尺骨茎突骨折之间差异有统计学意义。结论桡骨远端骨折桡侧移位对桡尺远侧关节的稳定性有较大的影响。桡尺远侧关节不稳中并发尺骨茎突骨折的患者较多,尺骨茎突骨折提示有较大几率伴发TFCC损伤。尺骨茎突的良好复位对桡尺远侧关节稳定性有重要作用。

Objective To investigate the causes of instability of distal radioulnar joint caused by displacement in distal radius fracture,and to analyze the importance of radial displacement in distal radius fracture to wrist stability.Methods There were 60 patients with distal radius fracture,22 males and 38 females,aged from 26 to 67 years,with an average age of 41 years.There were 29 cases with ulnar styloid process fracture and 31 cases without ulnar styloid process fracture.According to the degree of displacement,they were divided into three groups:13 cases with displacement less than 2 mm,20 cases with displacement more than 2 mm and less than 4 mm,and 27 cases with displacement more than 4 mm.All the patients were treated with open reduction and plate internal fixation of distal radius fracture.The stability of distal radioulnar joint was examined after plate fixation.Fifteen patients with unstable distal radioulnar joint examined by intraoperative physical examination(associated with ulnar styloid process fracture)were divided into two groups.In one group,the styloid process of ulna was fixed with steel wire,while in the other group the styloid process of ulna was not fixed.The effect of radial displacement on ulnar styloid process after distal radius fracture and the effect of ulnar styloid process fracture on the stability of distal radioulnar joint were analyzed.The degree of radial displacement of distal radius fracture and the effect of ulnar styloid process fracture on the stability of distal radioulnar joint were evaluated according to the postoperative follow-up of palmar inclination angle,ulnar deviation angle and wrist function score.Results The injury of TFCC when radial displacement of distal radius fracture was greater than 4 mm was the main cause of instability of distal radioulnar joint and affecting wrist function.There was statistically significant difference in the incidence of distal radioulnar joint instability whether distal radial fractures accompanied by ulnar styloid process fractures or not.There was significant difference between radial displacement greater than 4 mm and ulnar styloid process fracture.Conclusion The radial displacement of distal radius fracture has great influence on the stability of distal radioulnar joint.There are more patients with ulnar styloid process fracture in the instability of distal radioulnar joint.The ulnar styloid process fracture suggests a higher risk ofTFCC injury.The good reduction of ulnar styloid process plays an important role in the stability of distal radioulnar joint.