桡骨远端关节内骨折术后桡骨短缩的影响因素分析

目的 分析桡骨远端关节内骨折术后桡骨短缩的影响因素及临床意义。方法 对2003年1月- 2008年1月手术治疗桡骨远端关节内骨折54例进行临床随访，根据桡骨短缩是否＞4mm，分为桡骨短缩组（桡骨短缩距离＞4mm）和对照组(桡骨短缩距离＜4 mm)，比较两组患者骨折类型、骨折粉碎程度和骨缺损程度、年龄、手术入路和术中内固定物选择、术中是否植骨、术后掌倾角和尺偏角、腕关节功能评分等情况。结果 桡骨远端关节内骨折术后桡骨短缩发生率为30％；年龄因素、术中是否植骨对术后桡骨短缩有显著性影响；C型骨折较B型骨折术后桡骨短缩发生率显著性增高；手术入路和内固定物的选择对术后桡骨短缩的影响差异无统计学意义；桡骨短缩组与对照组比较，掌倾角和尺偏角差异无统计学意义，而腕关节功能评分优良率有所降低。结论 桡骨远端关节内骨折术后桡骨短缩发生率较高。手术治疗时应考虑可导致桡骨轴向短缩的因素，并采取相应的防治措施。

Influencing factors for radial shortening after surgical operation for intra-articular fractures of the distal radius

Objective To analyze the influencing factors and clinical results of radial shortening after operation of intra-articular fractures. Methods A total of 54 patients with intra-articular fractures of the distal radius treated surgically from January 2003 to January 2008 were followed up and divided into radial shortening group ( ＞ 4 mm) and control group ( ＜ 4 mm) by whether radial shortening was more than 4 mm. Fracture types, comminution and defection degree, age, surgical approach and internal fixation method, whether bone implant in operation, post-operative volar tilting angle and ulnar inclination angle, and wrist function score were investigated and compared between the two groups. Results The incidence of radial shortening in post-operation of intra-articular fractures of the distal radius was 30％.Age and whether bone implant in operation were significantly different between the two groups. Type C fractures were more liable to radial shortening than type B fractures. Operation approach and internal fixation method have no significant influence on the radial shortening. Volar tilting angle and ulnar inclination angle were not significantly different between the two groups and the excellent and good rate of function score was lower in the radial shortening group. Conclusion There is a high incidence of radial shortening after operation for the intra-articular fractures of the distal radius, which affects the clinical results of operation. Therefore, we should pay more attention to the influencing factors and take corresponding precaution methods during operation.