不同桡骨远端骨折分型方法中骨折类型与预后功能的关系分析  

Associations between different classifications of distal radius fracture and function after recovery

作　　者：王古衡[1] 谢仁国[1] 潘张军 茅天[1] 邢树国[1] 张昌军[1] 张宇轩[1] 李玉周[1] 

机构地区：[1]南通大学附属医院手外科,226001 [2]江苏省宜兴市人民医院手外科,214200

出　　处：《中华创伤骨科杂志》2016年第1期74-78,共5页Chinese Journal of Orthopaedic Trauma

基　　金：国家自然科学基金（81071479）;江苏省卫生厅“科教兴卫”工程重点人才基金（RC2011101）;南通大学自然科学类科研基金（132030）;南通大学附属医院院级课题（TDFY0323）

摘　　要：目的探讨不同骨折分型方法中不同桡骨远端骨折类型与预后功能的关系，分析各骨折类型预后特点及适合的治疗方法。方法回顾性分析2008年5月至2012年12月诊治并获完整随访的173例桡骨远端骨折的患者资料，统计桡骨远端骨折患者的性别、侧别及治疗方法选择的情况。研究根据术前X线片对每例骨折采用AO分型和Frykman分型方法分型，关节内骨折同时采用Mayo分型法进行分型，并统计各型的分布。末次随访时测量腕关节掌屈、背伸、桡偏、尺偏、旋前、旋后活动角度及手腕握力，并采用上肢功能评分表（DASH）评价上肢功能。结果173例患者术后获12～60个月（平均23．0个月）随访。AO分型C2型、C3型骨折患者的腕关节尺偏角（24．9°±8．2°、21．3°±7．3°）均明显小于A2型（33．3°±10．3°）与B1型（34．5°±7．6°），差异均有统计学意义（P〈0．05）。各测量指标在Frykman分型中组间差异无明显统计学意义（P〉0．05）。Mayo分型Ⅳ型骨折腕关节掌屈角（39．7°±12．6°）明显小于关节外骨折（46．7°±10．4°）和Ⅰ型（49．2°±9．5°），Ⅳ型腕关节尺偏角（23．1°±9．3°）明显小于关节外骨折（31．3°±9．9°），以上项目比较差异均有统计学意义（P〈0．05）。结论骨折线过关节面碎裂及移位明显者需以手术治疗为主，其中AO分型中C2和C3型需注意改善腕关节尺偏角，Frykman分型需重视伴有尺骨茎突骨折的处理，Mayo分型Ⅳ型需注意掌屈和尺偏角的恢复。Objective To investigate the associations between different classifications of distal radius fracture and function after recovery, and to analyze appropriate treatments for different types of fracture. Methods From May, 2008 to December, 2012, 230 patients with distal radial fracture were treated. We reviewed 173 patients of them who had been fully followed up. Their clinical data were analyzed in terms of age, gender, laterality, classifications （AO, Frykman and Mayo）, and treatments. At the last follow-up, we measured the flexion, extension, radial deviation, ulnar deviation, pronation and supination of the wrist and grip strength. Disability of Arm Shoulder and Hand （DASH） scores were used to evaluate the function of upper limb. Finally, the associations between each type of fracture and function after recovery, and the most suitable treatment were analyzed. Results The 173 patients were followed up for an average of 23.0 months （from 12 to 60 months）. In AO classification, the wrist ulnar deviation angle was 24. 9° ± 8.2° for type C2 and 21.3° ± 7.3° for type C3, significantly smaller than that for type A2 （33.3° ±10.3°） and for type B1 （34.5° ±7.6°） （ P 〈 0.05 ）. There was no significant difference between the measured parameters in Frykman Classification （ P 〉 0.05）. In Mayo Classification, the wrist flexion angle was 39.7°± 12.6° for type Ⅳ, significantly smaller than that for the extra-articular fracture group （46.7° ± 10.4°） and for type Ⅰ （49.2° ±9.5°） （ P 〈 0.05）, The wrist ulnar deviation angle was 23. 1° ±9.3° for type Ⅳ, significantly smaller than that for the extra-articular fracture group （31.3°±9. 9°） （P 〈 0. 05） . Conclusions Comminuted and obvious shifted intra-articular fractures need surgical treatment. It is necessary to improve the wrist ulnar deviation angle for types C2 and C3 by AO classification,and restore flexion and ulnar deviation angles for Mayo type Ⅳ. In Frykman classification we should pa

关 键 词：桡腕关节 桡骨骨折 功能恢复 分型 

分 类 号：R687.3[医药卫生—骨科学]