尺骨茎突骨折对桡骨远端骨折后腕关节功能的影响

目的通过比较伴或不伴尺骨茎突骨折的桡骨远端骨折患者临床资料,探讨尺骨茎突骨折对桡骨远端骨折后腕关节功能的影响。方法回顾分析2005年2月-2010年5月收治的182例伴或不伴尺骨茎突骨折的桡骨远端骨折患者临床资料,其中75例伴尺骨茎突骨折(A组),107例不伴尺骨茎突骨折(B组)。两组患者性别、年龄、病程、骨折分型等一般资料比较,差异均无统计学意义(P>0.05),具有可比性。A组采用闭合复位小夹板或石膏固定治疗42例,切开复位钢板内固定33例;B组分别为63例及44例。A组尺骨茎突骨折均未作处理。结果两组患者术后均获随访,其中A组平均随访时间为21个月,B组为20个月。切开复位内固定患者术后切口均Ⅰ期愈合。A组4例(5.3%)、B组6例(5.6%)患者出现腕关节尺侧疼痛,发生率比较差异无统计学意义(χ2=0.063,P=0.802)。X线片示两组桡骨远端骨折均愈合,A组愈合时间为(10.9±2.7)周,B组为(11.6±2.3)周,两组差异无统计学意义(t=1.880,P=0.062)。桡骨远端骨折愈合时两组掌倾角、尺偏角及桡骨长度比较,差异均无统计学意义(P>0.05)。末次随访时两组腕关节屈伸、桡尺偏、旋前旋后活动度及手握、捏力均相似(P>0.05)。Gartland-Werley腕关节评分:A组优24例,良43例,可5例,差3例,优良率89.3%;B组优35例,良57例,可10例,差5例,优良率86.0%;两组差异无统计学意义(Z=—0.203,P=0.839)。A组闭合复位外固定及切开复位内固定患者以上评价指标比较,差异均有统计学意义(P<0.05)。结论尺骨茎突骨折对桡骨远端骨折后腕关节功能无明显影响;对于伴尺骨茎突骨折的桡骨远端骨折,桡骨远端骨折解剖复位对腕关节功能的恢复具有重要意义。

Effect of associated ulnar styloid fracture on wrist function after distal radius

Objective To evaluate the effect of associated ulnar styloid fracture on wrist function after distal radius fracture by comparing the clinical data between the cases of distal radius fracture with or without ulnar styloid fractures.Methods The clinical data of 182 patients with distal radius fracture between February 2005 and May 2010 were retrospectively analyzed,including 75 with ulnar styloid fracture(group A),and 107 without ulnar styloid fracture(group B).There was no signi cant di erence in sex,age,disease duration,and fracture classi cation between 2 groups(P > 0.05).In groups A and B,closed reduction and splintlet or cast xation were performed in 42 and 63 cases respectively,and open reduction and internal xation in 33 and 44 cases respectively.All ulnar styloid fractures were not treated.Results The patients were followed up 21 months on average in group A and 20 months on average in group B.All incisions healed by rst intention after operation.Ulnar wrist pain occurred in 4 patients(5.3%) of group A and 6 patients(5.6%) of group B,showing no signi cant di erence(χ2=0.063,P=0.802).The fracture healing time was(10.9 ± 2.7) weeks in group A and(11.6 ± 2.3) weeks in group B,showing no signi cant di erence(t=1.880,P=0.062).There was no signi cant di erence in the palmar tilt angle,the ulnar inclination angle,and the radial length between groups A and B when fracture healing(P > 0.05).At last follow-up,there was no signi cant di erence in wrist exion-extension,radial-ulnar deviation,pronation-supination,and grip and pinch strength between 2 groups(P > 0.05).According to the Gartland-Werley score in groups A and B,the results were excellent in 24 and 35 cases,good in 43 and 57 cases,fair in 5 and 10 cases,and poor in 3 and 5 cases with execllent and good rate of 89.3% and 86.0%,respectively,showing no signi cant di erence between 2 groups(Z=—0.203,P=0.839).There were signi cant di erences in the above indexes between patients undergoing closed reduction and open reduction in group A(P < 0.05).Conclusion Associated ulnar styloid fracture has no obvious e ect on the wrist function after distal radius fracture.The anatomical reduction of distal radial fracture is the crucial importance in the treatment of distal radial fracture accompanying ulnar styloid fracture.