尺骨短缩术治疗桡骨骨折后尺骨撞击综合征

目的 评价尺骨短缩术治疗尺骨撞击综合征的效果及其影响因素. 方法 2002年1月至2006年12月对28例诊断为腕部尺骨撞击综合征患者给予尺骨截骨短缩治疗,采用改良的Gartland and Werley腕关节功能评分系统判定治疗效果;分析尺骨短缩数量与手术效果的关系. 结果 本组术前尺骨阳性变异23例,中件变异3例,阴性变异2例;术后阳性变异3例,中性变异4例,阴性变异21例.尺骨变异术前平均(3.1±2.3)mm,术后平均(0.9±1.4)mm,差异有统计学意义(t=4.32,P<0.05).按改良的Gartland and Werley评分:术前平均为(62.6±4.3)分,可21例,差7例;术后评分改善到平均为(92.2±7.8)分,优22例,良3例,可2例,差1例,腕关节功能评分术前与术后比较差异有统计学意义(t=10.45,P<0.05).3例切断尺桡远端韧带,4例部分切断尺桡远端韧带.6例术前存在远端尺腕部背侧半脱位,尺骨短缩术后明显改善. 结论 尺骨短缩术能显著改善桡骨远端骨折后继发尺骨撞击综合征的功能评分和临床症状;但尺骨短缩过多,远侧尺桡关节间压力增大,则影响手术效果.

Ulnar osteotomy tar ulnar impaction syndrome following distal radius fracture

Objective To evaluate the effect and influential factor of ulnar-shortening procedure for ulnar impaction syndrome after distal radius fracture. Methods From January 2002 to December 2006, 28 cases who had been diagnosed as ulnar impaetion syndrome following distal radius fracture received ul-nar-shortening procedure. The therapeutic effect for the injured wrist was assessed by the modified Gartland and Werley scoring system of wrist function. The relation between the operative outcome and the length of shortening was analyzed. Results Carpal anteroposterior X-ray film revealed 23 cases of ulnar positive variance, 3 cases of neutral variance and 2 cases of negative variance preoperatively, but 3 positive, 4 neutral and 21 negative ulnar variance postoperatively. The average ulnar variance was (3.1±2.3 )mm before ulnar-shortening procedure and (0.9±1.4) mm after operation. The modified Gartland and Wedey wrist function score was 62.6±4.3 preoperatively and 92.2±7.8 postoperatively. Before operation 21 cases were evaluated as fair and 7 as poor, but after operation 22 cases were evaluated as excellent, 3 fine, 2 fair and 1 poor. The radioulnar ligaments (RUL) were abscised in 3 cases and partly cut off in 4 cases. Ulnar-carpal dorsal semiluxation was found in 6 cases, but the deformity was redressed after ul-nar-shortening procedure. Conclusions The ulnar-shortening procedure may improve earpal function scores and clinical symptoms markedly in patients with ulnar impaction syndrome secondary to distal radius fractures. But the operative effectiveness can be affected by excessive ulnar-shortening which leads to increased pressure on the distal ulnoradial joint facets.