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北京大学学报（医学版） ›› 2020, Vol. 52 ›› Issue (3): 578-581. doi: 10.19723/j.issn.1671-167X.2020.03.027

• 论著 • 上一篇    下一篇

尺骨茎突与乙状切迹骨折对桡骨远端骨折患者术后腕关节功能的影响

张鹏1,2,贾波3,陈逍堃3,王宇3,黄伟1,2,赖人杰3,王志伟3,熊建2,3,王天兵1,2,3,△()   

  1. 1. 北京大学人民医院创伤救治中心,北京 100044
    2. 国家创伤医学中心,北京 100044
    3. 北京大学人民医院创伤骨科,北京 100044
  • 收稿日期:2018-08-16 出版日期:2020-06-18 发布日期:2020-06-30
  • 通讯作者: 王天兵 E-mail:wangtianbing@pkuph.edu.cn
  • 基金资助:
    国家重点基础研究发展计划(973 Program);国家重点基础研究发展计划(2014CB542200);国家自然科学基金(31371210);国家自然科学基金(31771326);北京市自然科学基金(7204321);国家重点研发计划(2018YFF0301103)

Effects of ulnar styloid and sigmoid notch fractures on postoperative wrist function of patients with distal radius fracture

Peng ZHANG1,2,Bo JIA3,Xiao-kun CHEN3,Yu WANG3,Wei HUANG1,2,Ren-jie LAI3,Zhi-wei WANG3,Jian XIONG2,3,Tian-bing WANG1,2,3,△()   

  1. 1. Department of Trauma Center, Peking University People’s Hospital, Beijing 100044, China
    2. National Center for Trauma Medicine, Beijing 100044, China
    3. Department of Trauma and Orthopedics, Peking University People’s Hospital, Beijing 100044, China
  • Received:2018-08-16 Online:2020-06-18 Published:2020-06-30
  • Contact: Tian-bing WANG E-mail:wangtianbing@pkuph.edu.cn
  • Supported by:
    National Basic Research Program of China(973 Program);National Basic Research Program of China(2014CB542200);National Natural Science Foundation of China(31371210);National Natural Science Foundation of China(31771326);Beijing Natural Science Foundation(7204321);National Key Research and Development Program of China(2018YFF0301103)

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摘要：

目的 研究尺骨茎突骨折与乙状切迹骨折对桡骨远端骨折患者术后腕关节功能的影响。方法 选择2006年1月至2016年6月就诊于北京大学人民医院创伤骨科桡骨远端骨折139例患者进行门诊随访,评分参照Gartland and Werley评分,以腕关节疼痛为重点进行疗效评定。结果 尺骨茎突基底部骨折组和乙状切迹骨折组的腕关节功能评分较差,尺骨茎突骨折行内固定治疗组的腕关节功能评分明显改善;尺骨茎突基底部骨折组的腕尺侧痛发生率较高;尺骨茎突基底部骨折的愈合率优于尖部骨折。结论 桡骨远端骨折手术治疗总体效果满意,尺骨茎突基底部骨折、乙状切迹骨折是导致桡骨远端骨折患者术后腕关节功能损害的危险因素。尺骨茎突基底部骨折是腕尺侧痛的危险因素之一,尺骨茎突基底部骨折的愈合率优于尖部骨折。尺骨茎突骨折行内固定治疗可改善患者术后腕关节功能。

关键词: 桡骨远端骨折, 尺骨茎突骨折, 腕尺侧痛, 乙状切迹

Abstract:

Objective: To study the effects of ulnar styloid and sigmoid notch fractures on postoperative wrist function in patients with distal radius fracture.Methods: In total, 139 patients treated for distal radius fracture in the Department of Orthopedic Trauma at Peking University People’s Hospital from Jan. 2006 to June 2016 were selected for outpatient follow-ups. Evaluation was based on Sartiento’s modification of the Gartland and Werley scores. Efficacy was assessed with wrist pain as the focus.Results: The excellent and good efficacy rate was 97.1% (excellent: n=107, 77.0%; good: n=28, 19.4%; and fair: n=4, 2.9%). Gender, age, and whether the ulnar styloid fracture achieved union did not significantly impact the scores (P>0.05). The scores of the basal fracture group were significantly different (P=0.001). Internal fixation of ulnar styloid fracture was associated with a significant difference in scores (P=0.005). The effect of sigmoid notch fracture was also associated with a significant difference in scores (P=0.024). This study included 22 cases of ulnar wrist pain, and the overall incidence of ulnar wrist pain was 15.8%. Gender, age, whether the ulnar styloid fracture achieved union, and whether internal fixation was conducted for ulnar styloid fracture and sigmoid notch fracture had no significant effect on the occurrence of ulnar wrist pain (P>0.05). The incidence of ulnar wrist pain was higher in basal fractures than that in tip fractures. Among ulnar styloid fractures, the union rate of basal fracture was higher than that of tip fractures. The union rates of basal fracture and tip fracture were significantly different (P<0.001). Basal fractures were significant risk factors for ulnar wrist pain (P=0.028). Basal fracture of the ulnar styloid group and sigmoid notch fracture group had poor wrist function scores. Wrist function score improved significantly after internal fixation of ulnar styloid fracture. The incidence of ulnar wrist pain was higher in basal fracture group. The union rate in basal fracture group was higher than in tip fracture group.Conclusion: The overall effect of surgical treatment of distal radius fracture is satisfactory. Ulnar styloid basal fracture and sigmoid notch fracture are risk factors for postoperative wrist dysfunction in patients with distal radius fracture, and the basal fracture is one of the risk factors of ulnar wrist pain. The union rate of ulnar styloid basal fractures is better than that of tip fractures. Internal fixation of ulnar styloid fracture can improve wrist function.

Key words: Distal radius fracture, Sigmoid notch, Ulnar styloid fracture, Ulnar wrist pain

中图分类号: 

  • R658.2

表1

Gartland和Werley评分的线性回归分析"

Items Gender, n Age/years,
x?±s		 Ulnar styloid
fracture, n		 Internal fixation of ulnar
styloid fracture, n		 Union of ulnar
styloid fracture, n		 Sigmoid notch
fracture, n
M F Basal Tip Y N Y N Y N
Gartland and Werley score
Excellent 23 84 55.4 ±1.3 33 44 12 64 26 51 18 89
Good 7 21 54.1±2.4 11 9 1 20 9 11 4 24
Fair 0 4 59.8±0.8 3 1 0 4 0 4 2 2
Poor 0 0 - 0 0 0 0 0 0 0 0
β 0.473 0.019 2.150 -1.229 -2.474 -0.688 2.093
SE 0.949 0.025 0.613 0.979 0.862 0.616 0.914
P 0.619 0.448 0.001 0.213 0.005 0.267 0.024

表2

腕尺侧痛的Logistic回归分析"

Items Gender, n Age/years,
x?±s		 Ulnar styloid
fracture, n		 Internal fixation of ulnar
styloid fracture, n		 Union of ulnar
styloid fracture, n		 Sigmoid notch
fracture, n
M F Basal Tip Y N Y N Y N
Ulnar wrist pain
Y 4 18 57.7±1.8 13 7 1 19 8 12 5 17
N 26 91 54.8±1.3 34 47 12 69 27 54 19 98
Incidence of ulnar wrist pain/% 13.3 16.5 - 27.7 13.0 7.7 21.6 22.9 18.2 20.8 14.8
Incidence of ulnar wrist pain/% 13.3 16.5 - 27.7 13.0 7.7 21.6 22.9 18.2 20.8 14.8
β -0.685 0.044 1.336 0.388 -21.010 0.249 0.902
SE 1.109 0.034 0.608 1.025 10 906.093 0.619 0.876
P 0.537 0.193 0.028 0.705 0.998 0.687 0.303

表3

不同类型尺骨茎突骨折的愈合率"

Items Fracture union, n Fracture nonunion, n Union rate/%
Basal 27 20 57.4
Tip 8 46 14.8
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