桡骨远端骨折对下尺桡关节稳定性的影响

目的:分析桡骨远端骨折后腕部功能与下尺桡关节稳定性之间的关系,探讨桡骨远端骨折影响下尺桡关节稳定性的原因。方法:85例桡骨远端骨折患者,男27例,女58例;年龄17~74岁,平均42.3岁。采用手法复位石膏外固定治疗,伤后6~9个月(平均6.7个月)摄腕关节正侧位X线CR片,检查下尺桡关节稳定性,采用Sarmiento改良的Gartland-Werley评分系统(GW评分)对腕部进行功能评估。结果:85例获得6~9个月随访,平均6.7个月。19例有下尺桡关节不稳定。下尺桡关节不稳与放射学检查下尺桡关节情况之间无明显的联系。下尺桡关节不稳的患者GW评分平均为12.37±5.899,稳定的患者GW评分平均为6.85±4.222,差异有统计学意义。尺骨茎突是否骨折其GW评分差异无统计学意义。是否有尺骨茎突骨折其下尺桡关节不稳发生率比较差异无统计学意义。结论:明显成角或短缩畸形的桡骨远端骨折损伤三角纤维软骨复合体可能是造成下尺桡关节不稳、影响腕部功能的主要原因。伴随桡骨远端骨折的尺骨茎突骨折对下尺桡关节稳定性无明显影响。

Effect of distal radial fractures on the stability of distal radiaoulnar joint

Objective:To analyze the relationship between wrist function following distal radial fractures and the stability of distal radioulnar joint,to explore the reasons that distal fractures affect the stability of distal radioulnar joint.Methods:Eight-five patients with distal radial fractures(58 female and 27 male,ranging in age from 17 to 74 years,with an average of 42.3 years)were treated with closed reduction and plaster cast.All patients had radiographic evaluation of their wrist joints and distal radioulnar joints for their stabilities,and undergone functional evaluation using modified Gartland and Werley demerit scoring system(GW score).Results:All the patients were followed-up and the duration ranged from 6 to 9 months,with an average of 6.7 months.Nineteen patients showed distal radioulnar joint instability.The distal radioulnar joint instability was not correlated to radiographic variable.The instable group had a statistically significant worse GW score(12.370±5.899) than that of the stable group(6.850±4.222).The GW scores in the distal radial fractures associated with fracture of the ulna styloid process group and without fractures of the ulna styloid process group had no statistically significant differences.There was no statistically significant difference in the incidence rate of the distal radioulnar joint instability between the distal radial fractures associated with fractures of the ulna styloid process and those without fractures of the ulna styloid process.Conclusion:Injury to the triangular fibrocartilage complex caused by the distal radial fractures with obvious axial shortening and angular deformities may be the main cause of the instability of distal radioulnar joint,while there are no obvious effects of the fracture of ulnar styloid process on the instability of distal radioulnar joint.