BACKGROUND Distal radius fractures accompanied by the volar margin of the lunate fossa(VMLF)lesions are often overlooked or inadequately reduced in clinical practice.AIM To investigate the impact of VMLF fragment in d...BACKGROUND Distal radius fractures accompanied by the volar margin of the lunate fossa(VMLF)lesions are often overlooked or inadequately reduced in clinical practice.AIM To investigate the impact of VMLF fragment in distal radius fractures on the stability and function of the wrist joint.METHODS This was a retrospective study of patients with distal radius fractures who underwent surgical treatment between January 2013 and December 2017.The patients were divided into two groups according to whether the VMLF fragments were fixed or not.X-rays and computed tomography were performed before surgery,immediately postoperatively,and at 1,3,and 6 mo to measure the scapholunate angle,radiolunate angle,capitolunate angle,and effective radiolunate flexion(ERLF).The Mayo wrist score and disabilities of the arm,shoulder,and hand(DASH)score were determined at 1 year.RESULTS Thirty-five patients were included.There were 15 males and 20 females.Their mean age was 52.5±14.3(range:19-70)years.There were 38 wrists(17 on the left side,15 on the right,and three bilateral;16 in the fixed group,and 22 in the unfixed group).The interval between trauma and surgery was from 1 h to 1 mo.The incidence of postoperative wrist instability in the unfixed group(86.4%)was higher than in the fixed group(25.0%)(P≤0.001).Ten patients had ERLF>25°in the unfixed group and none in the fixed group(P=0.019).The Mayo wrist score was 94±5.7 in the fixed group and 68±15.1 in the unfixed group(P<0.001).The DASH score was 4.6±2.5 in the fixed group and 28.5±19.5 in the unfixed group(P<0.001).CONCLUSION Injuries of VMLF,even small fractures,might damage the radial-lunar ligament,leading to postoperative wrist instability,sagittal force line imbalance,and poor recovery of wrist joint function.展开更多
Osteoporosis is a common metabolic skeletal disorder characterized by decreased bone mass and deteriorated bone structure, leading to increased susceptibility to fractures. With aging population, osteoporotic fracture...Osteoporosis is a common metabolic skeletal disorder characterized by decreased bone mass and deteriorated bone structure, leading to increased susceptibility to fractures. With aging population, osteoporotic fractures are of global health and socioeconomic importance. The three-dimensional microstructural information of the common osteoporosis-related fracture sites, including vertebra, femoral neck and distal radius, is a key for fully understanding osteoporosis pathogenesis and predicting the fracture risk. Low vertebral bone mineral density(BMD) is correlated with increased fracture of the spine. Vertebral BMD decreases from cervical to lumbar spine, with the lowest BMD at the third lumbar vertebra. Trabecular bone mass of the vertebrae is much lower than that of the peripheral bone. Cancellous bone of the vertebral body has a complex heterogeneous three-dimensional microstructure, with lower bone volume in the central and anterior superior regions. Trabecular bone quality is a key element to maintain the vertebral strength. The increased fragility of osteoporotic femoral neck is attributed to low cancellous bone volume and high compact porosity. Compared with age-matched controls, increased cortical porosity is observed at the femoral neck in osteoporoticfracture patients. Distal radius demonstrates spatial inhomogeneous characteristic in cortical microstructure. The medial region of the distal radius displays the highest cortical porosity compared with the lateral, anterior and posterior regions. Bone strength of the distal radius is mainly determined by cortical porosity, which deteriorates with advancing age.展开更多
Objective: To investigate the application of artificial tiger bone powder on fracture healing time, wrist functional recovery and quality of life (QOL) in elderly patients with distal radius fracture. Methods: The stu...Objective: To investigate the application of artificial tiger bone powder on fracture healing time, wrist functional recovery and quality of life (QOL) in elderly patients with distal radius fracture. Methods: The study was a randomised controlled trials performed from January 2015 to December 2016 in a hospital. Elderly patients with distal radius fracture were divided into the treatment and the control groups by the random sealed envelope method. All patients were given splint or plaster fixation after manipulative reduction, and functional exercise, the treatment group was also given artificial tiger bone powder orally (trade name: Jintiange capsule), the control group was given an oral placebo in their appearance and usage identical with the treatment group. Prior to treatment and 6, 12 months after treatment, the wrist function was assessed by range of motion, including flexion-extension, radial-ulnar and pronation-supination, and the QOL was assessed by the Mos 36-item Short Form Health Survey. Each patient's fracture healing time was recorded. Results: Before treatment, there were no significant differences in wrist function and QOL between the two groups. At 6 and 12 months after treatment, the wrist function and QOL in the treatment group were better than those in the control group, the differences were statistically significant (P < 0.05). The fracture healing time in the treatment group was shorter than that of the control group, and the difference was statistically significant (P < 0.05). Conclusion: The early usage of artificial tiger bone powder for elderly patients with distal radius fracture can promote the healing of fracture, recovery of wrist joint function, and ultimately improve the QOL for elderly patients.展开更多
Bone graft may be needed to fill bone defect in elderly patients with a metaphyseal comminuted distal radius fracture. In this retrospective, nonrandomized, single-surgeon study, we evaluated the clinical and radiolog...Bone graft may be needed to fill bone defect in elderly patients with a metaphyseal comminuted distal radius fracture. In this retrospective, nonrandomized, single-surgeon study, we evaluated the clinical and radiologic outcomes of using both dorsal locking plates with or without augmentation with mineralized collagen （MC） bone graft for elderly patients with dorsally metaphyseal comminuted radius fractures. Patients in group 1 （n = 12） were treated with dorsal locking plates with MC bone graft application into the metaphyseal bone defect, and those in group 2 （n - 12） only with dorsal locking plates. Clinical and radiologic parameters were determined at three and 12 months after surgery. At final follow-up, no significant difference was noted between the 2 groups in terms of palmar tilt and radial inclination （p - 0.80）; however, ulnar variance increased significantly in the group 2 treated with dorsal locking plates without augmentation （p〈0.05）. Functionally, there was no significant difference between the groups. Our preliminary study suggests that combination of MC as bone-graft substitutes and dorsal locking plates may be a usefully alternative for elderly patients with metaphyseal comminuted distal radius fracture.展开更多
Objective: To study the therapeutic effect of collapsed and comminuted distal radius fracture. Methods: Twenty-six patients with collapsed and comminuted distal radius fracture were hospitalized from July 1998 to June...Objective: To study the therapeutic effect of collapsed and comminuted distal radius fracture. Methods: Twenty-six patients with collapsed and comminuted distal radius fracture were hospitalized from July 1998 to June 2003. All fractures were treated by the methods of open reduction, sustained bone grafting and passing joint external fixator to restore the anatomic shape of distal radius. Results: All 26 cases were followed up, and the results showed that the fractures have been united radiographically. The joint surfaces were intact and there was no length discrepancy occurred in patient’s radius. The average volar tilt was 6° to 15° and the average ulnar tilt was 18° to 25°. According to the Dieust criterion, 19 cases were rated as excellent and 7 as good. Conclusions: The method that applying passing joint external fixator and bone grafting for the treatment of collapsed and comminuted distal radius fracture could maintain the stability of fracture and restore the length of radius and the intact of joint surface.展开更多
目的研究桡骨远端伸直型骨折患者应用中医正骨手法联合筋伤膏对腕关节活动度的影响。方法选取2018年3月—2020年3月酒泉市中医院收治的100例桡骨远端伸直型骨折患者为研究对象,按挂号的先后顺序分为对照组和观察组,各50例。对照组采用...目的研究桡骨远端伸直型骨折患者应用中医正骨手法联合筋伤膏对腕关节活动度的影响。方法选取2018年3月—2020年3月酒泉市中医院收治的100例桡骨远端伸直型骨折患者为研究对象,按挂号的先后顺序分为对照组和观察组,各50例。对照组采用西医复位治疗,观察组采用中医正骨手法联合筋伤膏治疗。比较两组临床疗效、临床指标变化、治疗前后视觉模拟评分量表(Visual Analog Scale,VAS)评分、腕关节功能改良加特兰德-韦利评分(Gartland-Werley,GW)及治疗前后腕关节活动度。结果观察组总有效率为100.00%高于对照组,差异有统计学意义(χ^(2)=5.982,P=0.014)。治疗后,观察组各项临床指标优于对照组,差异有统计学意义(P均<0.05)。治疗后,两组背伸度、掌屈度、旋后度明显升高,差异有统计学意义(P均<0.05),且观察组治疗后背伸度、掌屈度、旋后度更高,差异有统计学意义(P均<0.05)。治疗后,两组VAS、GW评分显著降低,差异有统计学意义(P均<0.05),且观察组治疗后VAS、GW评分更低,差异有统计学意义(P均<0.05)。结论桡骨远端伸直型骨折患者采用中医正骨手法联合筋伤膏治疗效果显著,可改善患者临床症状,促进骨折愈合,提高腕关节活动度。展开更多
目的研究C型桡骨远端骨折合并Ⅱ型(Hauck分型)尺骨茎突基底骨折时,克氏针张力带技术切开复位内固定治疗尺骨茎突骨折对桡骨远端骨折内固定术后腕关节功能的影响。方法回顾性分析2018年1月—2021年6月哈尔滨市第五医院骨科收治的87例C型...目的研究C型桡骨远端骨折合并Ⅱ型(Hauck分型)尺骨茎突基底骨折时,克氏针张力带技术切开复位内固定治疗尺骨茎突骨折对桡骨远端骨折内固定术后腕关节功能的影响。方法回顾性分析2018年1月—2021年6月哈尔滨市第五医院骨科收治的87例C型桡骨远端骨折同时合并Ⅱ型尺骨茎突基底骨折患者资料,男性32例,女性55例;年龄28~68岁,平均56.3岁;摔伤40例,高处坠落伤47例。根据尺骨茎突骨折是否固定分为固定组(46例)、对照组(41例),桡骨远端骨折均采用Henry入路切开复位掌侧锁定接骨板内固定,固定组行尺骨茎突切开复位克氏针张力带内固定,对照组给予前臂旋后位经皮自尺骨向桡骨克氏针间接固定。术后1d及1、3、12个月分别记录患者患肢功能参数(掌屈、背伸、旋前、旋后)、手指总主动活动度(total active motion,TAM)及视觉模拟评分(visual analogue scale,VAS),定期复查腕部X线片评估骨折愈合情况,记录骨折愈合时间。末次随访记录患肢腕尺侧疼痛发生率,关节功能评价使用Gartland-Werley功能评分、上肢功能(disability of arm,shoulder and hand,DASH)评分评定患肢功能。结果术后患者均获随访,随访时间13~26个月,平均16.4个月。两组桡骨远端骨折均达骨性愈合,骨折愈合时间比较差异无统计学意义。固定组尺骨茎突均骨性愈合,无畸形愈合或不愈合发生;对照组骨性愈合24例(其中畸形愈合14例),不愈合17例。术后1d、1个月,固定组患肢功能参数(掌屈、背伸、旋前、旋后)均明显优于对照组(P<0.05);术后3个月,固定组掌屈角度明显大于对照组(P<0.05),背伸角度及手指TAM比较差异无统计学意义;术后12个月,两组患者掌屈角度及手指TAM比较差异无统计学意义;术后所有时间节点旋后角度固定组均明显大于对照组(P<0.05);术后1d固定组VAS高于对照组,此后的时间节点固定组VAS均低于对照组,但差异无统计学意义(P>0.05);末次随访显示固定组尺侧旋转疼痛发生率(15.2%,7/46)明显低于对照组(51.2%,21/41,P<0.05),Gartland-Werley评分、DASH评分均优于对照组(P<0.05)。结论对于合并尺骨茎突基底骨折的C型桡骨远端骨折,尺骨茎突骨折切开复位内固定能够明显提高桡骨远端C型骨折术后腕关节功能,降低尺骨茎突畸形愈合、不愈合发生率。展开更多
基金High Levels of Health Technical Personnel in Beijing City Health System,No.2013-3-050.
文摘BACKGROUND Distal radius fractures accompanied by the volar margin of the lunate fossa(VMLF)lesions are often overlooked or inadequately reduced in clinical practice.AIM To investigate the impact of VMLF fragment in distal radius fractures on the stability and function of the wrist joint.METHODS This was a retrospective study of patients with distal radius fractures who underwent surgical treatment between January 2013 and December 2017.The patients were divided into two groups according to whether the VMLF fragments were fixed or not.X-rays and computed tomography were performed before surgery,immediately postoperatively,and at 1,3,and 6 mo to measure the scapholunate angle,radiolunate angle,capitolunate angle,and effective radiolunate flexion(ERLF).The Mayo wrist score and disabilities of the arm,shoulder,and hand(DASH)score were determined at 1 year.RESULTS Thirty-five patients were included.There were 15 males and 20 females.Their mean age was 52.5±14.3(range:19-70)years.There were 38 wrists(17 on the left side,15 on the right,and three bilateral;16 in the fixed group,and 22 in the unfixed group).The interval between trauma and surgery was from 1 h to 1 mo.The incidence of postoperative wrist instability in the unfixed group(86.4%)was higher than in the fixed group(25.0%)(P≤0.001).Ten patients had ERLF>25°in the unfixed group and none in the fixed group(P=0.019).The Mayo wrist score was 94±5.7 in the fixed group and 68±15.1 in the unfixed group(P<0.001).The DASH score was 4.6±2.5 in the fixed group and 28.5±19.5 in the unfixed group(P<0.001).CONCLUSION Injuries of VMLF,even small fractures,might damage the radial-lunar ligament,leading to postoperative wrist instability,sagittal force line imbalance,and poor recovery of wrist joint function.
文摘Osteoporosis is a common metabolic skeletal disorder characterized by decreased bone mass and deteriorated bone structure, leading to increased susceptibility to fractures. With aging population, osteoporotic fractures are of global health and socioeconomic importance. The three-dimensional microstructural information of the common osteoporosis-related fracture sites, including vertebra, femoral neck and distal radius, is a key for fully understanding osteoporosis pathogenesis and predicting the fracture risk. Low vertebral bone mineral density(BMD) is correlated with increased fracture of the spine. Vertebral BMD decreases from cervical to lumbar spine, with the lowest BMD at the third lumbar vertebra. Trabecular bone mass of the vertebrae is much lower than that of the peripheral bone. Cancellous bone of the vertebral body has a complex heterogeneous three-dimensional microstructure, with lower bone volume in the central and anterior superior regions. Trabecular bone quality is a key element to maintain the vertebral strength. The increased fragility of osteoporotic femoral neck is attributed to low cancellous bone volume and high compact porosity. Compared with age-matched controls, increased cortical porosity is observed at the femoral neck in osteoporoticfracture patients. Distal radius demonstrates spatial inhomogeneous characteristic in cortical microstructure. The medial region of the distal radius displays the highest cortical porosity compared with the lateral, anterior and posterior regions. Bone strength of the distal radius is mainly determined by cortical porosity, which deteriorates with advancing age.
文摘Objective: To investigate the application of artificial tiger bone powder on fracture healing time, wrist functional recovery and quality of life (QOL) in elderly patients with distal radius fracture. Methods: The study was a randomised controlled trials performed from January 2015 to December 2016 in a hospital. Elderly patients with distal radius fracture were divided into the treatment and the control groups by the random sealed envelope method. All patients were given splint or plaster fixation after manipulative reduction, and functional exercise, the treatment group was also given artificial tiger bone powder orally (trade name: Jintiange capsule), the control group was given an oral placebo in their appearance and usage identical with the treatment group. Prior to treatment and 6, 12 months after treatment, the wrist function was assessed by range of motion, including flexion-extension, radial-ulnar and pronation-supination, and the QOL was assessed by the Mos 36-item Short Form Health Survey. Each patient's fracture healing time was recorded. Results: Before treatment, there were no significant differences in wrist function and QOL between the two groups. At 6 and 12 months after treatment, the wrist function and QOL in the treatment group were better than those in the control group, the differences were statistically significant (P < 0.05). The fracture healing time in the treatment group was shorter than that of the control group, and the difference was statistically significant (P < 0.05). Conclusion: The early usage of artificial tiger bone powder for elderly patients with distal radius fracture can promote the healing of fracture, recovery of wrist joint function, and ultimately improve the QOL for elderly patients.
文摘Bone graft may be needed to fill bone defect in elderly patients with a metaphyseal comminuted distal radius fracture. In this retrospective, nonrandomized, single-surgeon study, we evaluated the clinical and radiologic outcomes of using both dorsal locking plates with or without augmentation with mineralized collagen （MC） bone graft for elderly patients with dorsally metaphyseal comminuted radius fractures. Patients in group 1 （n = 12） were treated with dorsal locking plates with MC bone graft application into the metaphyseal bone defect, and those in group 2 （n - 12） only with dorsal locking plates. Clinical and radiologic parameters were determined at three and 12 months after surgery. At final follow-up, no significant difference was noted between the 2 groups in terms of palmar tilt and radial inclination （p - 0.80）; however, ulnar variance increased significantly in the group 2 treated with dorsal locking plates without augmentation （p〈0.05）. Functionally, there was no significant difference between the groups. Our preliminary study suggests that combination of MC as bone-graft substitutes and dorsal locking plates may be a usefully alternative for elderly patients with metaphyseal comminuted distal radius fracture.
文摘Objective: To study the therapeutic effect of collapsed and comminuted distal radius fracture. Methods: Twenty-six patients with collapsed and comminuted distal radius fracture were hospitalized from July 1998 to June 2003. All fractures were treated by the methods of open reduction, sustained bone grafting and passing joint external fixator to restore the anatomic shape of distal radius. Results: All 26 cases were followed up, and the results showed that the fractures have been united radiographically. The joint surfaces were intact and there was no length discrepancy occurred in patient’s radius. The average volar tilt was 6° to 15° and the average ulnar tilt was 18° to 25°. According to the Dieust criterion, 19 cases were rated as excellent and 7 as good. Conclusions: The method that applying passing joint external fixator and bone grafting for the treatment of collapsed and comminuted distal radius fracture could maintain the stability of fracture and restore the length of radius and the intact of joint surface.
文摘目的研究桡骨远端伸直型骨折患者应用中医正骨手法联合筋伤膏对腕关节活动度的影响。方法选取2018年3月—2020年3月酒泉市中医院收治的100例桡骨远端伸直型骨折患者为研究对象,按挂号的先后顺序分为对照组和观察组,各50例。对照组采用西医复位治疗,观察组采用中医正骨手法联合筋伤膏治疗。比较两组临床疗效、临床指标变化、治疗前后视觉模拟评分量表(Visual Analog Scale,VAS)评分、腕关节功能改良加特兰德-韦利评分(Gartland-Werley,GW)及治疗前后腕关节活动度。结果观察组总有效率为100.00%高于对照组,差异有统计学意义(χ^(2)=5.982,P=0.014)。治疗后,观察组各项临床指标优于对照组,差异有统计学意义(P均<0.05)。治疗后,两组背伸度、掌屈度、旋后度明显升高,差异有统计学意义(P均<0.05),且观察组治疗后背伸度、掌屈度、旋后度更高,差异有统计学意义(P均<0.05)。治疗后,两组VAS、GW评分显著降低,差异有统计学意义(P均<0.05),且观察组治疗后VAS、GW评分更低,差异有统计学意义(P均<0.05)。结论桡骨远端伸直型骨折患者采用中医正骨手法联合筋伤膏治疗效果显著,可改善患者临床症状,促进骨折愈合,提高腕关节活动度。
文摘目的研究C型桡骨远端骨折合并Ⅱ型(Hauck分型)尺骨茎突基底骨折时,克氏针张力带技术切开复位内固定治疗尺骨茎突骨折对桡骨远端骨折内固定术后腕关节功能的影响。方法回顾性分析2018年1月—2021年6月哈尔滨市第五医院骨科收治的87例C型桡骨远端骨折同时合并Ⅱ型尺骨茎突基底骨折患者资料,男性32例,女性55例;年龄28~68岁,平均56.3岁;摔伤40例,高处坠落伤47例。根据尺骨茎突骨折是否固定分为固定组(46例)、对照组(41例),桡骨远端骨折均采用Henry入路切开复位掌侧锁定接骨板内固定,固定组行尺骨茎突切开复位克氏针张力带内固定,对照组给予前臂旋后位经皮自尺骨向桡骨克氏针间接固定。术后1d及1、3、12个月分别记录患者患肢功能参数(掌屈、背伸、旋前、旋后)、手指总主动活动度(total active motion,TAM)及视觉模拟评分(visual analogue scale,VAS),定期复查腕部X线片评估骨折愈合情况,记录骨折愈合时间。末次随访记录患肢腕尺侧疼痛发生率,关节功能评价使用Gartland-Werley功能评分、上肢功能(disability of arm,shoulder and hand,DASH)评分评定患肢功能。结果术后患者均获随访,随访时间13~26个月,平均16.4个月。两组桡骨远端骨折均达骨性愈合,骨折愈合时间比较差异无统计学意义。固定组尺骨茎突均骨性愈合,无畸形愈合或不愈合发生;对照组骨性愈合24例(其中畸形愈合14例),不愈合17例。术后1d、1个月,固定组患肢功能参数(掌屈、背伸、旋前、旋后)均明显优于对照组(P<0.05);术后3个月,固定组掌屈角度明显大于对照组(P<0.05),背伸角度及手指TAM比较差异无统计学意义;术后12个月,两组患者掌屈角度及手指TAM比较差异无统计学意义;术后所有时间节点旋后角度固定组均明显大于对照组(P<0.05);术后1d固定组VAS高于对照组,此后的时间节点固定组VAS均低于对照组,但差异无统计学意义(P>0.05);末次随访显示固定组尺侧旋转疼痛发生率(15.2%,7/46)明显低于对照组(51.2%,21/41,P<0.05),Gartland-Werley评分、DASH评分均优于对照组(P<0.05)。结论对于合并尺骨茎突基底骨折的C型桡骨远端骨折,尺骨茎突骨折切开复位内固定能够明显提高桡骨远端C型骨折术后腕关节功能,降低尺骨茎突畸形愈合、不愈合发生率。
