尺骨茎突Ⅱ型骨折对桡骨远端骨折术后腕关节功能的影响

Effect of ulnar styloid type Ⅱ fracture on wrist function after distal radius fracture

目的 探讨尺骨茎突Ⅱ型骨折对桡骨远端骨折(DRF)术后腕关节功能的影响。方法 回顾性分析自2019年1月—2021年1月我院收治的桡骨远端骨折接受手术的患者68例,按照有无尺骨茎突Ⅱ型骨折和是否行尺骨茎突内固定手术分为A组(无尺骨茎突Ⅱ型骨折,24例)、B组(有尺骨茎突Ⅱ型骨折无尺骨茎突骨折内固定,21例)、C组(有尺骨茎突Ⅱ型骨折又有尺骨茎突骨折内固定,23例)。记录患者AO分型及手术前、手术后6个月和手术后1年的X线片测量数据,对3组组间患者按照解剖学评分[掌倾角(PTA)、尺偏角(RA)、桡骨茎突高度(RSH))]及Gartlant-Werly(GW)功能评分优良率进行比较。结果 68例患者均进行随访,随访时间为7~12个月,平均随访时间10个月。末次随访时,68例DRF均愈合。3组患者术前、术后6个月及术后1年解剖学评分比较,差异均无统计意义(P>0.05)。A组与B组患者的GW功能评分优良率比较,差异有统计学意义(P<0.05);A组与C组患者的GW功能评分优良率比较,差异无统计学意义(P>0.05);B组与C组患者的GW功能评分优良率比较,差异有统计学意义(P>0.05)。结论 对桡骨远端骨折合并尺骨茎突Ⅱ型骨折,手术行尺骨茎突内固定能够恢复患者下尺桡关节的稳定性,明显改善患者术后腕关节功能,获得更好的预后。

Objective To investigate the effect of ulnar styloid typeⅡfracture on wrist function after distal radius fracture(DRF).Methods From January 2019 to January 2021,68 patients with distal radius fractures who underwent surgery in our hospital were divided into three groups of ABC according to whether there were ulnar styloid typeⅡfractures and whether intrasclubal styloid fixation surgery was performed,group A:no ulnar styloid stem typeⅡfractures;Group B:there are ulnar styloid typeⅡfractures without internal fixation of ulnar styloid fractures;Group C:there are ulnar stem process typeⅡfractures and internal fixation of ulnar stem fractures.The AO classification and X-ray measurement data before surgery,6 months after surgery and 1 year after surgery were recorded,and the excellent rates of function scores of patients in groups A,B and C were compared according to their anatomical scores(Palm tilt angle(PTA),Ruler angle(RA),Radial stem height(RSH))and Gartlant-Werly(GW)function scores.Results The difference in preoperative general data of patients in A,B and C groups was not statistically significant and could be compared.All 68 patients were followed up for 7 to 12 months(average follow-up time was 10 months).At the last follow-up,all 68 DRF cases healed.There was no significant difference in the anatomical scores of patients in groups A,B and C before surgery for 6 months and 1 year after surgery(P>0.05).The difference was statistically significant(P<0.05)between the GW functional scores of patients in group A and group B(P<0.05).The difference was not statistically significant(P>0.05)between patients in group A and group C(P>0.05).Conclusion Distal radius fracture combined with ulnar styloid typeⅡfracture,surgical internal fixation of the ulnar stem can restore the stability of the patient's lower ulnar radial joint,significantly improve the postoperative wrist joint function of the patient,and obtain a better prognosis.