尺骨短缩截骨术治疗桡骨远端骨折畸形愈合的生物力学研究  

Biomechanical study on ulnar shortening osteotomy for treatment of distal radius fracture malunion Wang

作　　者：王明鑫[1] 尹望平[1] 曾庆敏[1] 陈延超[1] 葛喆 戴正寿[2] 

机构地区：[1]复旦大学附属金山医院骨科,上海201508 [2]复旦大学人体解剖与组织胚胎学系

出　　处：《中华手外科杂志》2017年第3期205-208,共4页Chinese Journal of Hand Surgery

基　　金：上海市卫生和计划生育委员会面上项目（2014_399）;上海市金山区卫生和计划生育委员会面上项目（JSKJ-KTMS-2015-11）

摘　　要：目的探讨桡骨远端骨折短缩畸形愈合后，行尺骨短缩截骨术对桡尺远侧关节旋转稳定性的影响。方法在10具新鲜的成人上肢尸体标本上建立桡骨远端骨折（AO分型的23C1．2）短缩愈合模型，使用掌侧锁定钢板内固定后，行尺骨下段斜形阶梯状截骨，依次行克氏针和钢板内固定，比较截骨、克氏针、钢板三种处理方式，腕部最大旋前和旋后扭矩的变化。结果最大旋前和旋后扭矩：对照组为（1．59±1．03）N·m和（1．85±1．21）N·m，桡骨远端骨折组为（1．44±0．93）N·m和（1．63±1．18）N·m，尺骨截骨组为（1．22±0．83）N·m和（1．20±0．83）N·m，尺骨克氏针内固定组为（1．24±0．78）N·m和（1．30±0．87）N·m，尺骨钢板内固定组为（1．37±0．85）N·m和（1．71±1．44）N·m。与尺骨截骨组比较，克氏针内固定组最大旋前、旋后扭矩差异均无统计学意义，钢板内固定组旋前、旋后扭矩差异均有统计学意义；克氏针和钢板内固定比较，最大旋前扭矩差异有统计学意义，旋后扭矩差异无统计学意义。结论类似于榫卯结构的尺骨下段斜形阶梯状截骨术，不行内固定或仅行经皮克氏针内固定，加上外部制动控制适当的旋转，是一种治疗桡骨远端骨折等导致的腕尺侧痛的有效方法。Objective To investigatethe effect on distal radioulnar joint （DRUJ） stability of ulnar shortening osteotomy for treatment of distal radius fracture malunion. Methods The model of distal radius fracture（AO type 23C1.2） malunion with radial shortening was created on 10 fresh adult upper limb cadaver specimens. The distal radius fracture was fixed with volar locking plate, and the oblique step ulnar shortening osteotomy was made, The changes of maximum pronation and supination torques from no internal fixation, Kirschner wires fixation and locking plate fixation for ulnar shorting osteotomy were compared. Results The maximum pronation and supination torques were （1.59±1.03） Nom and （1.85±1.21） Nom in the control model, （1.44±0.93） N·m and （1.63±1.18） N·m in the distal radius fracture model, （1.22±0.83） N·m and （1.20±.83） Nora in the only ulnar shortening osteotomy model, （1.24± 0.78） N·m and （1.30±0.87） N·m in Kirschner wires fixation model, （1.37±0.85） N·m and （1.71±1.44） N·m in locking plate fixation model. Compared with the only ulnar shortening osteotomy model, there were no differences in the maximum pronafion and supination torques of the Kirschner wires fixation model, while there were significant differences in that of the locking plate model fixation. There were significant differences in the maximum pronation torque and no differences in the maximum supination torque between the Kirschner wires and the locking plate fixation models. Conclusion The oblique step ulnar shortening osteotomy, similar to tenon-mortise structure, with no internal fixation or just percutaneous Kirschner wires fixation combined with external immobilization to control wrist rotation, is an effective method for treatment of ulnar-sided wrist pain caused by malunited distal radial fractures.

关 键 词：桡骨骨折 尺骨截骨 生物力学 桡尺远侧关节 

分 类 号：R687.3[医药卫生—骨科学]