克氏针联合吸收线"8"字张力带固定法在桡骨远端骨折合并Ⅱ型尺骨茎突骨折中的应用效果观察

Application of Kirschner wire combined with 8-shape fixation of tension band with absorbable thread in treatment of distal radius fractures complicated by typeⅡulnar styloid fractures

目的探讨克氏针联合吸收线"8"字张力带固定法在桡骨远端骨折(DRF)合并Ⅱ型尺骨茎突骨折(USF)中的应用效果。方法抽取郑州市骨科医院2019年1月至2021年3月收治的110例DRF伴Ⅱ型USF患者,采用随机数字表法分为对照组和治疗组,每组55例。两组DRF的处理均采取掌侧锁定钢板行切开复位内固定,治疗组采取克氏针联合可吸收线"8"字张力带固定法处理Ⅱ型USF,对照组未处理Ⅱ型USF,术后仅采取夹板或石膏外固定。随访6个月,记录两组手术情况、影像学指标(桡骨高度、掌倾角、尺偏角)、并发症发生率;评估疗效(Gartland-Werley腕关节功能评分)、腕关节活动度及上肢功能(DASH功能评分系统)。结果治疗组手术时间长于对照组(P<0.05),但术后功能锻炼介入时间、骨折愈合时间均短于对照组(P均<0.05)。两组术后6周、6个月桡骨高度、掌倾角、尺偏角均较术前改善(P均<0.05),但治疗组与对照组同时间点桡骨高度、掌倾角、尺偏角值比较差异未见统计学意义(P>0.05)。治疗组术后并发症总发生率(7.27%,4/55)低于对照组(21.82%,12/55),P<0.05。术后6个月,治疗组Gartland-Werley腕关节功能评分低于对照组(P<0.05),疗效优良率(90.91%,50/55)高于对照组(70.91%,39/55),P<0.05;治疗组腕关节旋前旋后、屈伸、尺桡偏活动度均高于对照组(P均<0.05),DASH上肢功能评分低于对照组(P<0.05)。结论 DRF伴Ⅱ型USF患者在切开复位内固定处理DRF的基础上,采用克氏针联合可吸收线"8"字张力带对Ⅱ型USF进行固定,更利于患者早期功能锻炼及骨折愈合,还能减少术后并发症、提高疗效、促进腕关节功能恢复。

Objective To investigate the application effect of Kirschner wire combined with 8-shape fixation of tension band with absorbable thread in the treatment of distal radius fractures(DRF)complicated by typeⅡulnar styloid fractures(USF).Methods A total of 110 patients with DRF complicated by typeⅡUSF treated in Zhengzhou Orthopedic Hospital from January 2019 to March 2021 were selected.And they were divided into the control group and the treatment group according to the random number table method,with 55 cases in each group.Both groups were treated by volar locking plate for open reduction internal fixation in DRF treatment.The treatment group was treated by Kirschner wire combined with 8-shape fixation of tension band with absorbable thread for typeⅡUSF treatment,while the control group did not deal with USF and only adopted splint or plaster external fixation after surgery.Patients were followed up for 6 months to record the surgical status,imaging indicators(radius height,palm inclination angle,ulnar deflection angle)and incidence of complications of the two groups.The efficacy(Gartland-Werley wrist function score),wrist range of motion and upper limb function assessed by disability of arm,shoulder and hand(DASH)function scoring system were assessed.Results The surgical duration in treatment group was longer than that in control group(P<0.05),but the postoperative functional exercise intervention time and fracture healing time were shorter than those in control group(all P<0.05).The radius height,palm inclination angle and ulnar deflection angle in the two groups were improved 6 weeks and 6 months after surgery,compared with those before surgery(all P<0.05).There was no statistically significant difference in the radius height,palm inclination angle and ulnar deflection angle between treatment group and control group at the same time point(P>0.05).The total incidence of postoperative complications in the treatment group(7.27%,4/55)was lower than that in the control group(21.82%,12/55),P<0.05.The Gartland-Werley wrist function score in the treatment group was lower than that in the control group 6 months after surgery(P<0.05),and the excellent and good rate of curative effect in the treatment group was 90.91%(50/55),higher than 70.91%(39/55)in the control group(P<0.05).The wrist ranges of motions of pronation and supination,flexion and extension and radial ulnar deviation in treatment group were greater than those in control group(all P<0.05),and the DASH upper limb function score was lower than that in control group(P<0.05).Conclusions On the basis of open reduction internal fixation for DRF in patients with DRF complicated by typeⅡUSF,Kirschner wire combined with 8-shape fixation of tension band with absorbable thread for USF fixation is more conducive to early functional exercise and fracture healing,and can reduce postoperative complications,improve efficacy,promote the recovery of wrist function.