固定下尺桡关节对桡尺骨远端骨折术后的影响
Effect of Immobilization of Distal Radio-Ulnar Joint on Wrist Function with Distal Radius Fracture and Ulnar Fracture
摘要: 目的：研究桡骨远端骨折并尺骨茎突骨折的患者在桡骨远端及尺骨茎突均固定后，是否行下尺桡关节固定对其术后功能的影响。方法：我院自2016年7月到2019年1月，有28例桡骨远端骨折并尺骨茎突骨折的病例在桡骨行钢板内固定后，术中行下尺桡关节应力实验显示下尺桡关节不稳定，同时行尺骨茎突骨折内固定。其中13例用1枚克氏针固定下尺桡关节于中立位(下尺桡关节固定组A组)，15例不固定下尺桡关节(下尺桡关节不固定组B组)。记录患者的一般资料、抓握力、关节活动度及影像学资料，用Gartland & Werley功能评分表[1]进行评分，比较两组患者治疗疗效。结果：28例均获得随访，随访时间(6~36)个月。复查X线片显示骨折均愈合，关节面恢复平整，掌倾角、尺偏角及桡骨高度恢复正常。术后无骨折畸形愈合及不愈合、钢板螺钉松动或断裂等并发症发生。A组1例出现腕关节功能不满意，B组1例出现腕关节功能不满意。利用Gartland & Werley功能评分[1]后进行分析，其差异无统计学意义(P > 0.05)。结论：桡骨远端骨折并尺骨茎突骨折，在均进行内固定后，不需要对下尺桡关节进行内固定或外固定，术后早期即可进行功能锻炼。
Abstract: Objective: To study the effect of distal radio-ulnar joint fixation on postoperative function in pa-tients with distal radius fracture and ulnar styloid fracture after both distal radius and ulnar styloid fixation. Methods: From July 2016 to January 2019, 28 cases of distal radius fractures and ulnar fractures were fixed with plate of radius. The stress experiment of the distal radio-ulnar joint showed that the distal radio-ulnar joint was unstable. At the same time, the ulnar styloid fracture was immobilized. Among them, 13 cases were fixed with a Kirschner’s needle at the neutral position (group A), and 15 cases were not fixed (group B). Record the patient’s general data, grip force, joint activity and imaging data, using Gartland & Werley’s functional score [1] to compare the therapeutic effects of the two groups. Results: All 28 cases were followed up for 6 - 36 months. The X-ray examination showed that the fractures were all healed, the joint surface was restored, and the metacarpal inclination, ulnar declination, and radius height returned to normal. There were no complications such as fracture malformation and nonunion, plate screw loosening or fracture. In group A, 1 case wrist function was unsatisfactory, and in group B, 1 case wrist function was un-satisfactory. Gartland & Werley’s function score [1] was analyzed and its difference was not statis-tically significant (P > 0.05). Conclusion: The distal radius fracture and ulnar styloid fracture, after all internal fixation, there is no need for internal fixation or external fixation of the distal ra-dio-ulnar joint, and functional exercise can be performed early after operation.
文章引用：李修国, 刘永涛, 刘小智, 庞波涛, 王莹莹, 宋坤修. 固定下尺桡关节对桡尺骨远端骨折术后的影响[J]. 外科, 2019, 8(4): 89-93. https://doi.org/10.12677/HJS.2019.84014

参考文献

[1] 孙勇飞, 林志红, 尹善青. 桡骨远端骨折合并与不合并尺骨茎突基底部骨折的手术疗效比较[J]. 中国骨与关节损伤杂志, 2012, 27(5): 460-461.
[2] Sammer, D.M., Shah, H.M., Shauver, M.J., et al. (2009) The Effect of Ulnar Styloid Fractures on Patient-Rated Outcomes after Volar Locking Plating of Distal Radius Fractures. Journal of Hand Surgery—American Volume, 34, 1595-1602. [Google Scholar] [CrossRef] [PubMed]
[3] 刘小智, 刘永涛. 桡骨远端骨折导致下尺桡关节不稳的研究进展[J]. 滨州医学院校报, 2019, 42(1): 46-48+51.
[4] Schmidt, H.M. (2004) The Anatomy of the Ulnocarpal Complex. Orthopade, 33, 628-637.
[5] Kleinman, W.B. (2007) Stability of the Distal Radioulnar Joint: Biomechanics, Pathophysiology, Physical Diagnosis, and Restoration of Function What We Have Learned in 25 Years. Journal of Hand Surgery—American Volume, 32, 1086-1106. [Google Scholar] [CrossRef] [PubMed]
[6] Henry, M.H. (2008) Management of Acute Triangular Fibrocarti-lage Complex Injury of the Wrist. American Academy of Orthopaedic Surgeons, 16, 320-329. [Google Scholar] [CrossRef] [PubMed]
[7] Haugstvedt, J.R., Berger, R.A., Nakamura, T., et al. (2006) Relative Contributions of the Ulnar Attachments of the Triangular Fibrocartilage Complex to the Dynamic Sta-bility of the Distal Radioulnar Joint. Journal of Hand Surgery—American Volume, 31, 445-451. [Google Scholar] [CrossRef] [PubMed]
[8] 李晓, 侯忠军, 于胜军, 等. 探讨具有手术指征的特殊类型的尺骨茎突骨折[J]. 实用手外科杂志, 2017, 1(31): 108-109.
[9] 曾卡斌, 潘俊晖, 吴天旺. 尺骨茎突骨折类型对桡骨远端骨折治疗效果的影响[J]. 中国骨与关节损伤杂志, 2018, 33(1): 88-89.
[10] Wijffels, M., Brink, P. and Schipper, I. (2012) Clinical and Non-Clinical Aspects of Distal Radioulnar Joint Instability. The Open Orthopaedics Journal, 6, 204-210. [Google Scholar] [CrossRef] [PubMed]
[11] 孙勇飞, 林志红, 尹善青. 桡骨远端骨折合并与不合并尺骨茎突基底部骨折的手术疗效比较[J]. 中国骨与关节损伤杂志, 2012, 27(5): 460-461.
[12] Sammer, D.M., Shah, H.M., Shauver, M.J., et al. (2009) The Effect of Ulnar Styloid Fractures on Patient-Rated Outcomes after Volar Locking Plating of Distal Radius Fractures. Journal of Hand Surgery—American Volume, 34, 1595-1602. [Google Scholar] [CrossRef] [PubMed]
[13] 刘小智, 刘永涛. 桡骨远端骨折导致下尺桡关节不稳的研究进展[J]. 滨州医学院校报, 2019, 42(1): 46-48+51.
[14] Schmidt, H.M. (2004) The Anatomy of the Ulnocarpal Complex. Orthopade, 33, 628-637.
[15] Kleinman, W.B. (2007) Stability of the Distal Radioulnar Joint: Biomechanics, Pathophysiology, Physical Diagnosis, and Restoration of Function What We Have Learned in 25 Years. Journal of Hand Surgery—American Volume, 32, 1086-1106. [Google Scholar] [CrossRef] [PubMed]
[16] Henry, M.H. (2008) Management of Acute Triangular Fibrocarti-lage Complex Injury of the Wrist. American Academy of Orthopaedic Surgeons, 16, 320-329. [Google Scholar] [CrossRef] [PubMed]
[17] Haugstvedt, J.R., Berger, R.A., Nakamura, T., et al. (2006) Relative Contributions of the Ulnar Attachments of the Triangular Fibrocartilage Complex to the Dynamic Sta-bility of the Distal Radioulnar Joint. Journal of Hand Surgery—American Volume, 31, 445-451. [Google Scholar] [CrossRef] [PubMed]
[18] 李晓, 侯忠军, 于胜军, 等. 探讨具有手术指征的特殊类型的尺骨茎突骨折[J]. 实用手外科杂志, 2017, 1(31): 108-109.
[19] 曾卡斌, 潘俊晖, 吴天旺. 尺骨茎突骨折类型对桡骨远端骨折治疗效果的影响[J]. 中国骨与关节损伤杂志, 2018, 33(1): 88-89.
[20] Wijffels, M., Brink, P. and Schipper, I. (2012) Clinical and Non-Clinical Aspects of Distal Radioulnar Joint Instability. The Open Orthopaedics Journal, 6, 204-210. [Google Scholar] [CrossRef] [PubMed]