尺骨茎突骨折对C型桡骨远端骨折术后疗效的影响

The effect of ulnar styloid fracture on the postoperative outcome of type C distal radius fracture

目的探讨合并尺骨茎突骨折与否及其不同分型对C型桡骨远端骨折术后疗效的影响。方法自2013年1月至2018年6月,我们共收治71例C型桡骨远端骨折患者,根据是否合并尺骨茎突骨折及其不同分型分为A组(不合并尺骨茎突骨折)、B组(合并HauckⅠ型尺骨茎突骨折)和C组(合并HauckⅡ型尺骨茎突骨折)。所有桡骨远端骨折均行掌侧锁定接骨板内固定,尺骨茎突骨折均未行内固定。记录各组骨折愈合时间、术后并发症;末次随访时测量影像学参数(掌倾角、尺偏角、桡骨高度)、腕关节活动范围(掌屈、背伸、尺偏、桡偏、旋前、旋后)及握力;采用DASH评分评定患肢功能。结果术后所有患者均获得随访,时间为9~25个月,平均(15.6±4.1)个月。所有患者桡骨远端骨折均愈合,三组骨折愈合时间差异无统计学意义(F=2.078,P>0.05);末次随访时各影像学参数、腕关节活动范围及患侧健侧握力比差异无统计学意义(P>0.05);各组患者腕关节功能均获得良好恢复,三组DASH评分差异无统计学意义(F=2.305,P>0.05)。B组患者尺骨茎突骨折畸形愈合9例,不愈合3例;C组尺骨茎突骨折畸形愈合11例,不愈合2例;B组和C组尺骨茎突骨折愈合情况差异无统计学意义(χ2=1.252,P>0.05)。结论桡骨远端骨折行掌侧锁定接骨板内固定时,合并的尺骨茎突骨折未行固定存在较高的畸形愈合及不愈合风险;但尺骨茎突骨折与否及其不同骨折类型对术后腕关节功能恢复无明显影响。

Objective To explore the influence of ulnar styloid fractures and their different types on the postoperative outcome of type C distal radius fracture.Methods From January 2013 to June 2018, 71 patients with type C distal radius fracture were divided into group A (without ulnar styloid fracture), group B (with Hauck type Ⅰ ulnar styloid fracture) and group C (with Hauck type Ⅱ ulnar styloid fracture) according to whether they were combined with ulnar styloid fractures and their different types. All the distal radius fractures were fixed with volar locking plate, and the ulnar styloid fractures were not fixed. The time of fracture healing and postoperative complications were recorded. The radiographic parameters (volar tilt, ulnar deviation, radial height), the range of wrist movement (flexion, extension, ulnar deviation, radial deviation, pronation, supination) and grip strength were measured at the last follow-up. The function of affected limb was evaluated by DASH score.Results All the patients were follow-up for 9 to 25 months, with an average of (15.6±4.1) months. All the distal radius fractures healed, and there was no significant difference in the time of fracture healing among the three groups (F=2.078, P>0.05). At the last follow-up, there was no significant difference in the radiographic parameters, the range of wrist movement and the grip strength ratio of the affected side to the healthy side (P>0.05). There was no significant difference in the DASH scores among the three groups (F=2.305, P>0.05). There were 9 cases of malunion and 3 cases of nonunion in group B, 11 cases of malunion and 2 cases of nonunion in group C. There was no significant difference in healing of ulnar styloid fractures between group B and group C (χ2=1.252, P>0.05).Conclusion When the distal radius fracture was fixed with volar locking plate, the risk of malunion and nonunion was high when ulnar styloid fracture was not fixed. However, whether combined with ulnar styloid fracture or not and different fracture types have no significant effect on the functional recovery of wrist joint after operation.