桡骨远端乙状切迹背侧骨块不同治疗对腕关节功能恢复的探讨

目的探讨桡骨远端乙状切迹背侧移位骨块的不同治疗对腕关节功能恢复的影响。方法从2009年1至2012年12月通过对40例桡骨远端Frykman分型Ⅶ-Ⅷ型骨折患者手术治疗，分为可靠内固定和未可靠内固定（未固定或固定发生移位）两组进行随访，骨性愈合后患腕拍正位片并作2mm层厚的CT平扫，检查下尺桡关节恢复情况，应用握力计及采用Gartland-Werley评分系统（GW评分）对腕部进行功能评估，观察桡骨远端乙状切迹背侧移位骨块不同固定对腕关节功能恢复的影响。结果所有病例得到随访，时间为3—22个月，平均7．5个月。骨折均愈合，平均骨折愈合时间2．3个月。无感染患者、无内固定松动及腕管综合征等并发症，无腕背侧肌腱磨损疼痛或肌腱断裂者。通过Gartland—Werley评分可靠内固定组预后优良率明显提高。与未可靠内固定组比较，有统计学意义。结论桡骨远端乙状切迹背侧移位骨块给予可靠内固定术，可以增加下尺桡关节的稳定性，明显改善腕关节功能恢复。

Preliminary exploration on correlation between different treatments of dorsoulnar fragment of distal radius fractures and functional recovery of wrist joint

Objective To study and compare the functional results of the wrist by using different treatments for displaced dorsoulnar fragment of distal radius fractures. Methods From January 2009 to December 2012, a retrospective analysis of the wrist function and the distal radioulnar joint stability was carried out. The patients whose Frykman classification were stage Ⅶ and Ⅷ, were enrolled and treated by open reduction and internal fixation. 40 patients were followed up. According to the fixation status, the patients were divided into the dorsoulnar-fragment-fixation group and the dorsoulnar-fragment-nonfixation group. After achieving bone union, all the patients received anteriorposterior and lateral X-rays combined with 2 mm-sliee computer tomography scan. A detailed wrist functional evaluation was performed including the grip strength, the range of motion （extension-flexion and pronation-supination） and Gartland- Werley scoring system （GW score ）. The distal radioulnar stability of the two groups was also assessed. Results All the patients were followed up 3 to 22 months （ average 7.5 months）. Bony union occurred in all the patients and the average time was 2.3 months. There was no infection, hardware loosening, carpal tunnel syndrome, tendon irritation or rupture. According to Gartland-Werley scoring system, the results of the patients who received reliable fixation were superior to those of non-fixation. There was significant difference between the two groups by rank-sum test. Conclusion A specific-fixation of dorsoulnar fragment in distal radius fracture can improve the stability of distal radioulnar joint and the excellent rate.