切开复位空心螺钉内固定与克氏针内固定治疗尺骨茎突基底部骨折的对比研究

目的:比较切开复位空心螺钉内固定与切开复位克氏针内固定治疗尺骨茎突基底部骨折的临床疗效和安全性。方法:回顾性分析104例尺骨茎突基底部骨折患者的病例资料,其中采用切开复位空心螺钉内固定治疗42例(空心螺钉内固定组),采用切开复位克氏针内固定治疗62例(克氏针内固定组)。比较2组患者的骨折愈合率、Cooney腕关节评分、腕关节旋转疼痛发生率及并发症发生率。结果:所有患者均获得随访,随访时间12~36个月,中位数18个月。切口均甲级愈合。术后12个月,空心螺钉内固定组骨折愈合率、Cooney腕关节评分均高于克氏针内固定组[χ^2=6.674,P=0.010;(91.27±6.52)分,(85.32±4.62)分,t=2.530,P=0.014];2组患者腕关节旋转疼痛发生率比较,差异无统计学意义(χ^2=3.296,P=0.069)。克氏针内固定组5例发生克氏针退针;其中3例克氏针松动导致腕部疼痛明显,提前取出克氏针后腕部疼痛显著减轻;2例腕部疼痛较轻,未予以特殊处理,术后12个月常规取出克氏针后腕部疼痛消失。空心螺钉内固定组患者未发生螺钉松动。2组患者均未发生神经血管损伤、骨折复位丢失等并发症。2组患者并发症发生率比较,差异无统计学意义(χ^2=3.558,P=0.059)。结论:采用切开复位空心螺钉内固定治疗尺骨茎突基底部骨折相较于切开复位克氏针内固定,更有利于骨折愈合和腕关节功能恢复,二者的安全性相当。

A comparative study of open reduction and hollow screw internal fixation versus open reduction and Kirschner wire internal fixation for treatment of ulnar styloid base fractures

Objective:To compare the clinical curative effects and safety of open reduction and hollow screw internal fixation versus open reduction and Kirschner wire internal fixation for treatment of ulnar styloid base fractures.Methods:The medical records of 104 patients with ulnar styloid base fractures were analyzed retrospectively.Forty-two patients were treated with open reduction and hollow screw internal fixation(group A),while the others were treated with open reduction and Kirschner wire internal fixation(group B).The fracture healing rate,Cooney wrist score,wrist rotation pain incidence and complication incidence were compared between the 2 groups.Results:All patients in the 2 groups were followed up for 12-36 months with a median of 18 months and all patients in the 2 groups got primary healing in the surgical incisions.At 12 months after the surgery,the fracture healing rate and Cooney wrist scores were higher in group A compared to group B(χ^2=6.674,P=0.010;91.27+/-6.52 vs 85.32+/-4.62 points,t=2.530,P=0.014).There was no statistical difference in wrist rotation pain incidence between the 2 groups(χ^2=3.296,P=0.069).The Kirschner wire withdrawal was found in 5 patients in group B,in which obvious and mild wrist pains were found in 3 and 2 patients respectively.The obvious wrist pains of the 3 patients were significantly alleviated after the Kirschner wire was removed in advance,while no special treatment was performed on the 2 patients with mild wrist pains and the pain disappeared after the Kirschner wire was routinely removed at 12 months after the surgery.No screw loosening was found in group A.No complications such as neurovascular injury and fracture reduction loss were found in the 2 groups.There was no statistical difference in complication incidences between the 2 groups(χ^2=3.558,P=0.059).Conclusion:Open reduction and hollow screw internal fixation is more conducive to the fracture healing and wrist function recovery compared to open reduction and Kirschner wire internal fixation in treatment of ulnar styloid base fractures,while they are similar to each other in safety.