低能量损伤老年患者中尺骨茎突骨折与桡骨远端骨折移位程度及骨密度的关系分析

Study on the Relationship between Ulnar Styloid Fracture and Distal Radius Fracture Displacement and Bone Mineral Density in Elderly Patients with Low-Energy Injury

目的:研究低能量损伤老年患者中尺骨茎突骨折与桡骨远端骨折移位程度和骨密度的相关性。方法:2018年1月至2020年1月,60例患者(女55例,男5例,年龄为50~89岁),因跌倒引起桡骨远端骨折,排除高能量损伤导致的骨折。根据有无尺骨茎突骨折将患者分为两组。分析复位前的影像学资料,通过测量桡骨高度、掌倾角、尺偏角评估骨折移位情况。损伤1周内用双能X线骨密度仪测量腰椎、股骨颈。通过末次随访上肢功能评定表(DASH)评分和腕关节活动度评估腕关节功能。结果:合并尺骨茎突骨折组患者与无尺骨茎突骨折组的股骨颈部位骨密度值、桡骨高度、掌倾角、尺偏角差异均有统计学意义(P<0.05)。所有受试者数据的Logistic回归分析表明,掌倾角与尺骨茎突骨折存在显著相关性(P=0.045)。两组患者术后腕关节功能差异无统计学意义。结论:低能量损伤桡骨远端骨折老年患者中尺骨茎突骨折,其股骨颈骨密度降低与骨折的严重移位程度(桡骨高度、掌倾角、尺偏角)有相关性。

Objective:To investigate the relationship between ulnar styloid fracture(USF)and bone mineral density,serological bone conversion indices,and degree of fracture displacement in Chinese adults over 50 years old with distal radius fractures(DRF).Methods:60 patients(55 females and 5 males,range 50 to 89 years old)had DRF due to falls from January 2018 to January 2020.Fracture caused by high-energy injury was excluded.Patients were divided into two groups based on the presence or absence of USF.Fracture displacement was assessed by measuring radius height,palmar angle,and ulnar angle during pre-reduction imaging.Bone mineral density(BMD)of lumbar spine,femoral neck and distal radius were measured by dual light energy X-ray bone density meter within 1 week of injury.Wrist function was assessed by the DASH(disabilities of the arm,shoulder and hand)score and range of motion at the last follow-up.Results:There were statistically significant differences in BMD value of femoral neck,radius height,angle of radial inclination and angle of volar tilt between the USF group and the non-USF group(P<0.05).Logistic regression analysis of data from all subjects showed that there was a significant correlation between palmar inclination and USF(P=0.045).There was no significant difference in postoperative wrist function between the two groups.Conclusion:The presence of USF in low-energy DRF is associated with decreased femoral neck BMD and severe fracture displacement(radius height,angle of radial inclination and angle of volar tilt).