摘要
背景:对于多数桡骨远端Die-punch骨折,通过手法闭合复位即可达到功能复位,但是此类损伤多为中青年患者,他们对骨折愈合后腕关节功能的要求更高,是否手术治疗能取得更好的效果?目的:分析手术与保守治疗桡骨远端中间柱掌侧Die-punch骨折的效果。方法:选择山西医科大学第二医院2010-01-01/2020-12-31收治的桡骨远端中间柱掌侧Die-punch骨折患者41例,其中保守组(n=19)进行手法复位石膏外固定治疗,手术组(n=22)进行切开复位金属锁定接骨板置入内固定治疗。术后1年,拍摄X射线片,测量尺偏角、掌倾角、桡骨高度,通过Scapholunate角、放射物角、小头角评估腕关节的稳定性,通过有效放射性月骨屈曲角评估病理性腕关节半脱位;检测腕关节活动度,通过臂、肩、手功能障碍(DASH)评分及Mayo评分评估腕关节功能。结果与结论:(1)41例患者获得术后平均14.5个月随访,术后平均8.5周获得骨性愈合,未出现内固定松动、断裂等并发症;(2)术后1年,手术组患者掌倾角、腕关节掌屈角度大于保守组(P <0.001),桡骨高度沉降值少于保守组(P <0.001),腕关节不稳定率低于保守组(18%,79%,P <0.001);手术组未出现病理性腕关节半脱位,保守组有4例出现病理性腕关节半脱位,组间比较差异有显著性意义(P <0.001);(3)术后1年,手术组患者DASH评分低于保守组(P <0.001),Mayo评分高于保守组(P <0.001);(4)结果表明,相比于保守治疗,切开复位内固定治疗桡骨远端中间柱掌侧Die-punch骨折可获得更为稳定的腕关节、更优的腕关节功能。
BACKGROUND:For most Die-punch fra ctures of the distal radius,functional reset can be achieved by manual closed reduction.However,most of these injuries are young and middle-aged patients.They have higher requirements for wrist joint function after fracture healing.It remains poorly unde rstood whether surgical treatment can achieve better results.OBJECTIVE:To analyze the clinical effect of surgical treatment and conservative treatment of distal middle column Die-Punch fra cture.METHODS:Totally 41 cases of Die-punch fra ctures of the volar side of the medial column of the distal radius were selected from the Second Hos pital of Shanxi Medical University from January 1,2010 to December 31,2020.In the conservative treatment group(n=19),patients underwent manual reduction and plaster external fixation.In the surgical treatment group(n=22),patients underwent open reduction and internal fixation with metal locking plate.At 1 year after surge ry,the patients underwent X-ray to measure the palmar angle,ulnar deviation angle and radius height.The stability of the wrist joint was assessed by Scapolunate angle,radial angle,and capitolunate angle.Pathological wrist subluxation was assessed by effective radioscapholunateflexion angle to measure wrist range of motion.Wrist joint function was assessed by the disabilities of arm,shoulder and hand sco re and Mayo score.RESULTS AND CONCLUSION:(1) The mean follow-up time was 14.5 months in 41 patients,and the mean bone healing was 8.5 weeks.There were no complications such as loosening and fracture of internal fixation.(2) At 1 year after surgery,the palm inclination angle and wrist flexion angle of the patients in the surgical treatment group were greater than those in the conservative treatment group(P <0.001).Radial height settlement value was less in the surgical treatment group than that in the conservative treatment group(P <0.001).Wrist instability rate was lower in the surgical treatment group than that in the conservative treatment group(18%,79%;P <0.001).There was no pathological subluxation of the wrist joint in the surgical treatment group and four cases of pathological subluxation of the wrist joint in the conservative treatment group,and there was a significant difference between the two groups(P <0.001).(3)One year after surgery,disabilities of arm,shoulder and hand score in the surgical treatment group were lower than those in the conservative treatment group(P <0.001),and the Mayo score was higher than that in the conservative treatment group(P <0.001).(4) The res ults suggest that compared with conservative treatment,open reduction and internal fixation for distal middle column palmaral Die-punch fra cture can achieve more stable wrist joint and better wrist joint function.
作者
赵宇航
杨朝晖
Zhao Yuhang;Yang Zhaohui(Department of Orthopedics,Second Hospital of Shanxi Medical University,Taiyuan 030000,Shanxi Province,China)
出处
《中国组织工程研究》
CAS
北大核心
2023年第22期3544-3549,共6页
Chinese Journal of Tissue Engineering Research
