不固定下尺桡关节治疗桡骨远端骨折合并下尺桡关节不稳定的病例对照研究

目的：探讨桡骨远端骨折合并下尺桡关节不稳的治疗方式。方法：2007年6月至2009年12月，采取切开复位内固定治疗不稳定型桡骨远端骨折264例，其中42例术中发现合并下尺桡关节不稳，20例采取克氏针固定下尺桡关节或旋后位石膏外固定治疗（固定组），22例未行固定（非固定组）。术后对握力和腕关节活动范围进行观察；采用Sarmiento改良的Gaaland-WeAey评分系统（GW评分）对腕部功能进行评估，并测试下尺桡关节稳定性。结果：41例患者均获得1年以上随访，所有患者桡骨远端骨折均在术后3个月内获得愈合，下尺桡关节均对合良好，没有出现明显半脱位或脱位。两组患者的握力、腕关节活动范围及GW评分差异无统计学意义（P〉0．05）。l例发生远期下尺桡关节不稳。结论：对桡骨远端骨折合并下尺桡关节不稳定采用锁定钢板固定系统治疗桡骨远端骨折的同时，固定与不固定下尺桡关节临床效果无差异，因此对于合并下尺桡关节不稳的桡骨远端骨折，若桡骨远端骨折能获得满意的解剖复位，不推荐l期固定下尺桡关节。

A case control study on the treatment of distal radioulnar joint instability combined with distal radius fractures between fixation and non-fixation distal radioulnar joint

Objective: To explore the options on treatment of distal radioulnar joint instability combined with distal radius fracture. Methods: From June 2007 to December 2009, 264 patients with unstable distal radius fractures were treated with open reduction and internal fixation, in which 42 patients combined with distal radioulnar instability. Distal radioulnar joints of 20 patients were fixed with Kirschner wire or plaster cast at supinator position, and other distal radioulnar joints of 22 patients were not fixed. Range of motion of wrist joints and grip strength were observed;function of wrist were evaluated by modified Gartland-Werley scoring system (GW score);stability of distal radioulnar joints were tested at final follow-up. Results: Forty-one patients were followed up more than 1 year. All fractures obtained healing within 3 months after operation, and apposition of joints was good, no significant subluxation or dislocation were found. There were not statistical differences in grip strength, motion of joints and GW score between two groups (fixation and non-fixation). Only one patient occurred chronic distal radioulnar instability. Conclusion: There was no significant difference between fixation and non fixation for the treatment of distal radius fractures with distal radioulnar joint instability. For this reason, if fractures can be satisfactory reduced, there is no need for the one-stage distal radioulnar joint fixation.