• 廣西中醫(yī)學(xué)院附屬瑞康醫(yī)院骨科（南寧，530011）;

目的 通過比較伴或不伴尺骨莖突骨折的橈骨遠(yuǎn)端骨折患者臨床資料，探討尺骨莖突骨折對橈骨遠(yuǎn)端骨折后腕關(guān)節(jié)功能的影響。 方法 回顧分析2005 年2 月－ 2010 年5 月收治的182 例伴或不伴尺骨莖突骨折的橈骨遠(yuǎn)端骨折患者臨床資料，其中75 例伴尺骨莖突骨折（A 組），107 例不伴尺骨莖突骨折（B 組）。兩組患者性別、年齡、病程、骨折分型等一般資料比較，差異均無統(tǒng)計(jì)學(xué)意義（P  gt; 0.05），具有可比性。A 組采用閉合復(fù)位小夾板或石膏固定治療42 例，切開復(fù)位鋼板內(nèi)固定33 例；B 組分別為63 例及44 例。A 組尺骨莖突骨折均未作處理。 結(jié)果 兩組患者術(shù)后均獲隨訪，其中A 組平均隨訪時(shí)間為21 個(gè)月，B 組為20 個(gè)月。切開復(fù)位內(nèi)固定患者術(shù)后切口均Ⅰ期愈合。A 組4 例（5.3%）、B 組6 例（5.6%）患者出現(xiàn)腕關(guān)節(jié)尺側(cè)疼痛，發(fā)生率比較差異無統(tǒng)計(jì)學(xué)意義（χ2=0.063，P=0.802）。X 線片示兩組橈骨遠(yuǎn)端骨折均愈合，A 組愈合時(shí)間為（10.9 ± 2.7）周，B 組為（11.6 ± 2.3）周，兩組差異無統(tǒng)計(jì)學(xué)意義（t=1.880，P=0.062）。橈骨遠(yuǎn)端骨折愈合時(shí)兩組掌傾角、尺偏角及橈骨長度比較，差異均無統(tǒng)計(jì)學(xué)意義（P  gt; 0.05）。末次隨訪時(shí)兩組腕關(guān)節(jié)屈伸、橈尺偏、旋前旋后活動度及手握、捏力均相似（P  gt; 0.05）。Gartland-Werley 腕關(guān)節(jié)評分：A 組優(yōu)24 例，良43 例，可5 例，差3 例，優(yōu)良率89.3%；B 組優(yōu)35 例，良57 例，可10 例，差5 例，優(yōu)良率86.0%；兩組差異無統(tǒng)計(jì)學(xué)意義（Z= —0.203，P=0.839）。A 組閉合復(fù)位外固定及切開復(fù)位內(nèi)固定患者以上評價(jià)指標(biāo)比較，差異均有統(tǒng)計(jì)學(xué)意義（P  lt; 0.05）。 結(jié)論 尺骨莖突骨折對橈骨遠(yuǎn)端骨折后腕關(guān)節(jié)功能無明顯影響；對于伴尺骨莖突骨折的橈骨遠(yuǎn)端骨折，橈骨遠(yuǎn)端骨折解剖復(fù)位對腕關(guān)節(jié)功能的恢復(fù)具有重要意義。

引用本文： 李書振,陳躍平,林宗漢,范鍥,崔偉,豐哲. 尺骨莖突骨折對橈骨遠(yuǎn)端骨折后腕關(guān)節(jié)功能的影響. 中國修復(fù)重建外科雜志, 2012, 26(6): 666-671. doi: 復(fù)制

1. Abramo A, Kopylov P, Geijer M, et al. Open reduction and internal fixation compared to closed reduction and external fixation in distal radial fractures: a randomized study of 50 patients. Acta Orthop, 2009, 80(4): 478-485.
2. Lindau T, Arner M, Hagberg L. Intraarticular lesions in distal fractures of the radius in young adults. A descriptive arthroscopic study in 50 patients. J Hand Surg (Br), 1997, 22(5): 638-643.
3. Richards RS, Bennett JD, Roth JH, et al. Arthroscopic diagnosis of intra-articular soft tissue injuries associated with distal radial fractures. J Hand Surg (Am), 1997, 22(5): 772-776.
4. Stoffelen D, De Smet L, Broos P. The importance of the distal radioulnar joint in distal radial fractures. J Hand Surg (Br), 1998, 23(4): 507-511.
5. Mikic ZD. Treatment of acute injuries of the triangular fibrocartilage complex associated with distal radioulnar joint instability. J Hand Surg (Am), 1995, 20 (2): 319-323.
6. Lindau T, Adlercreutz C, Aspenberg P. Peripheral tears of the triangular fibrocartilage complex cause distal radioulnar joint instability after distal radial fractures. J Hand Surg (Am), 2000, 25(3): 464-468.
7. Kazemian GH, Bakhshi H, Lilley M, et al. DRUJ instability after distal radius fracture: a comparison between cases with and without ulnar styloid fracture. Int J Surg, 2011, 9(8): 648-651.
8. Buijze GA, Ring D. Clinical impact of United versus nonunited fractures of the proximal half of the ulnar styloid following volar plate fixation of the distal radius. J Hand Surg (Am), 2010, 35(2): 223-227.
9. Kim JK, Yun YH, Kim DJ, et al. Comparison of united and nonunited fractures of the ulnar styloid following volar-plate fixation of distal radius fractures. Injury, 2011, 42(4): 371-375.
10. Lindau T, Hagberg L, Adlercreutz C, et al. Distal radioulnar instability is an independent worsening factor in distal radial fractures. Clin Orthop Relat Res, 2000, (376): 229-235.
11. Roysam GS. The distal radio-ulnar joint in Colles’ fractures. J Bone Joint Surg (Br), 1993, 75(1): 58-60.
12. Sarmiento A, Pratt GW, Berry NC, et al. Colles’ fractures. Functional bracing in supination. J Bone Joint Surg (Am), 1975, 57(3): 311-317.
13. Gartland JJ Jr, Werley CW. Evaluation of healed Colles’ fractures. J Bone Joint Surg (Am), 1951, 33-A(4): 895-907.
14. May MM, Lawton JN, Blazar PE. Ulnar styloid fractures associated with distal radius fractures: incidence and implications for distal radioulnar joint instability. J Hand Surg (Am), 2002, 27(6): 965-971.
15. Zenke Y, Sakai A, Oshige T, et al. The effect of an associated ulnar styloid fracture on the outcome after fixation of a fracture of the distal radius. J Bone Joint Surg (Br), 2009, 91(1): 102-107.
16. Kim JK, Koh YD, Do NH. Should an ulnar styloid fracture be fixed following volar plate fixation of a distal radial fracture? J Bone Joint Surg (Am), 2010, 92(1): 1-6.
17. May MM, Lawton JN, Blazar PE. Ulnar styloid fractures associated with distal radius fractures: incidence and implications for distal radioulnar joint instability. J Hand Surg (Am), 2002, 27(6): 965-971.
  1. 1. Abramo A, Kopylov P, Geijer M, et al. Open reduction and internal fixation compared to closed reduction and external fixation in distal radial fractures: a randomized study of 50 patients. Acta Orthop, 2009, 80(4): 478-485.
  2. 2. Lindau T, Arner M, Hagberg L. Intraarticular lesions in distal fractures of the radius in young adults. A descriptive arthroscopic study in 50 patients. J Hand Surg (Br), 1997, 22(5): 638-643.
  3. 3. Richards RS, Bennett JD, Roth JH, et al. Arthroscopic diagnosis of intra-articular soft tissue injuries associated with distal radial fractures. J Hand Surg (Am), 1997, 22(5): 772-776.
  4. 4. Stoffelen D, De Smet L, Broos P. The importance of the distal radioulnar joint in distal radial fractures. J Hand Surg (Br), 1998, 23(4): 507-511.
  5. 5. Mikic ZD. Treatment of acute injuries of the triangular fibrocartilage complex associated with distal radioulnar joint instability. J Hand Surg (Am), 1995, 20 (2): 319-323.
  6. 6. Lindau T, Adlercreutz C, Aspenberg P. Peripheral tears of the triangular fibrocartilage complex cause distal radioulnar joint instability after distal radial fractures. J Hand Surg (Am), 2000, 25(3): 464-468.
  7. 7. Kazemian GH, Bakhshi H, Lilley M, et al. DRUJ instability after distal radius fracture: a comparison between cases with and without ulnar styloid fracture. Int J Surg, 2011, 9(8): 648-651.
  8. 8. Buijze GA, Ring D. Clinical impact of United versus nonunited fractures of the proximal half of the ulnar styloid following volar plate fixation of the distal radius. J Hand Surg (Am), 2010, 35(2): 223-227.
  9. 9. Kim JK, Yun YH, Kim DJ, et al. Comparison of united and nonunited fractures of the ulnar styloid following volar-plate fixation of distal radius fractures. Injury, 2011, 42(4): 371-375.
  10. 10. Lindau T, Hagberg L, Adlercreutz C, et al. Distal radioulnar instability is an independent worsening factor in distal radial fractures. Clin Orthop Relat Res, 2000, (376): 229-235.
  11. 11. Roysam GS. The distal radio-ulnar joint in Colles’ fractures. J Bone Joint Surg (Br), 1993, 75(1): 58-60.
  12. 12. Sarmiento A, Pratt GW, Berry NC, et al. Colles’ fractures. Functional bracing in supination. J Bone Joint Surg (Am), 1975, 57(3): 311-317.
  13. 13. Gartland JJ Jr, Werley CW. Evaluation of healed Colles’ fractures. J Bone Joint Surg (Am), 1951, 33-A(4): 895-907.
  14. 14. May MM, Lawton JN, Blazar PE. Ulnar styloid fractures associated with distal radius fractures: incidence and implications for distal radioulnar joint instability. J Hand Surg (Am), 2002, 27(6): 965-971.
  15. 15. Zenke Y, Sakai A, Oshige T, et al. The effect of an associated ulnar styloid fracture on the outcome after fixation of a fracture of the distal radius. J Bone Joint Surg (Br), 2009, 91(1): 102-107.
  16. 16. Kim JK, Koh YD, Do NH. Should an ulnar styloid fracture be fixed following volar plate fixation of a distal radial fracture? J Bone Joint Surg (Am), 2010, 92(1): 1-6.
  17. 17. May MM, Lawton JN, Blazar PE. Ulnar styloid fractures associated with distal radius fractures: incidence and implications for distal radioulnar joint instability. J Hand Surg (Am), 2002, 27(6): 965-971.