尺骨茎突基底部骨折内固定对腕关节功能的影响

Effect of internal fixation of ulnar styloid process base fracture on wrist function

背景:桡骨远端骨折合并尺骨茎突基底部骨折在临床中常见,因其骨折及周围韧带、软骨组织的双重破坏,导致桡尺远侧关节不稳定。以往对尺骨茎突基底部骨折不够重视,往往会出现手术后腕关节疼痛、活动范围受限等并发症的发生,治疗方案存在争议。目的:探讨桡骨远端骨折术中一期行尺骨茎突基底部骨折内固定对腕关节功能恢复的影响。方法:回顾性分析东营市人民医院在2018年6月至2020年12月收治的创伤致桡骨远端合并尺骨茎突基底部骨折并行手术治疗患者40例,桡骨远端骨折治疗方式均为行切开复位内固定。根据在桡骨手术完成后是否行尺骨茎突基底部内固定,将患者分为内固定组和对照组,每组20例。收集患者术前及术后6,12个月随访X射线片测量数据,比较两组患者的尺偏角、掌倾角及桡骨高度;术后1年记录腕关节背伸、掌屈、桡偏、尺偏、旋前、旋后方向的活动范围,应用加特兰德-韦利(Gartland-Werley)评分标准评定疗效。结果与结论:术后随访时,两组患者所测量的腕关节掌倾角、尺偏角、桡骨高度均优于术前(P<0.05),但两组间比较差异无显著性意义(P>0.05);术后1年内固定组腕关节背伸、掌屈、桡偏、尺偏、旋前、旋后方向的活动范围均优于对照组(P<0.05);术后1年内固定组疗效优良率90%,明显高于对照组55%(P<0.05)。结果表明,桡骨远端骨折术中一期行尺骨茎突基底部骨折内固定有利于进一步恢复腕关节功能。

BACKGROUND:Fractures of the distal radius and the base of the styloid process of the ulna are common in clinical practice.Because of the double destruction of the fracture and the surrounding ligaments and cartilage,the distal radioulnar joint is unstable.In the past,insufficient attention was paid to the fracture of the base of the styloid process of the ulna,which often led to complications such as wrist joint pain and limited range of motion after surgery,and the treatment plan was controversial.OBJECTIVE:To investigate the effect of internal fixation on the function of the wrist joint with fracture of ulnar styloid process base in distal radius fracture.METHODS:Clinical data of 40 patients with traumatic distal radius fractures accompanied by ulnar styloid process base fractures treated with concurrent surgical treatment in Dongying People’s Hospital from June 2018 to December 2020 were retrospectively analyzed.All distal radius fractures were operated by open reduction and internal fixation.According to whether the fracture of the base of ulnar styloid process was treated surgically or not,the patients were divided into the internal fixation group and control group,with 20 cases in each group.The measured data of X-ray films were collected before and 6 and 12months after operation,and the ulnar inclination,palmar tilt and radial height of the two groups were compared.The ranges of motion of the wrist joint in dorsal extension,palmar flexion,radial deviation,ulnar deviation,pronation and supination directions were recorded 1 year after operation.The effect was evaluated with the Gartland-Werley scoring standard.RESULTS AND CONCLUSION:At the follow-up after operation,palmar tilt,ulnar inclination and radial height of the wrist joint of the two groups were all better than those before operation(P<0.05),but the difference was not statistically significant between the two groups(P>0.05).The ranges of motion of the wrist joint in dorsal extension,palmar flexion,radial deviation,ulnar deviation,pronation and supination directions were better in the internal fixation group than those in the control group 1 year after operation(P<0.05).The excellent and good rate of the internal fixation group(90%)1 year after the operation was significantly higher than that of the control group(55%)(P<0.05).These findings conclude that one-stage internal fixation of ulnar styloid process base fracture during the operation of distal radius fracture is conducive to further recovery of wrist function.