Sauve-Kapandji手术于青壮年桡骨远端陈旧性骨折合并下尺桡关节脱位中的应用  

The Sauve-Kapandji procedure for old fracture of distal radius combined with distal radioulnar joint dislocation in young adults

作　　者：郑晓勇[1] 赵东升[1] 余清文[1] 马远征[1] 马忠立 Zheng Xiaoyong;Zhao Dongsheng;Yu Qingwen;Ma Yuanzheng;Ma Zhongli(Orthopaedics Department of the 8th Medical Center of Chinese PLA general Hospital,Beijing,100091;Qinghe Clinic,Rocket Army General Hospital,Beijing,100088,China)

机构地区：[1]解放军总医院第八医学中心骨科,北京100091 [2]火箭军总医院清河门诊部,北京100088

出　　处：《生物骨科材料与临床研究》2019年第6期55-57,61,共4页Orthopaedic Biomechanics Materials and Clinical Study

摘　　要：目的探讨Sauve-Kapandji手术治疗青壮年桡骨远端陈旧性骨折合并下尺桡关节脱位的临床疗效。方法选取2008年1月至2014年1月采用Sauve-Kapandji手术治疗的7例桡骨远端陈旧性骨折合并下尺桡关节脱位的青壮年患者,并对其进行随访。观察指标包括腕关节疼痛程度、腕关节活动度、腕关节功能及影像学评价,腕关节功能评定采用Gartland-Werley腕关节功能评分。结果7例患者均获得随访,随访时间18~70个月,平均(27.5±3.7)个月。术后切口均愈合良好,无感染等并发症。术前腕关节VAS疼痛评分为(4.8±1.7)分,术后末次随访VAS疼痛评分为(2.3±1.1)分,差异有统计学意义(P<0.05)。腕关节背伸活动度术前为(15.3±2.1)°,术后为(26.9±1.7)°;掌屈活动度术前为(18.5±2.7)°,术后为(45.1±3.2)°;前臂旋前活动度术前为(35.7±2.8)°,术后为(71.3±2.1)°;前臂旋后活动度术前为(16.5±2.5)°,术后为(41.3±3.5)°,差异均有统计学意义(P<0.05)。影像学检查示尺骨远端的正性变异均矫正为无变异,下尺桡关节融合牢固,尺骨远端假关节内无新骨形成。Gartland-Werley腕关节功能评分方面,优3例,良3例,中1例,优良率达85.71%。结论尺骨短缩、下尺桡关节融合术是治疗青壮年桡骨远端陈旧性骨折合并下尺桡关节脱位的一种安全、有效的方法。该手术既保留了腕关节的尺侧支撑,维持了下尺桡关节的稳定,又缓解了腕关节的疼痛并改善了前臂旋转功能。Objective To investigate the treatment outcome of Sauve-Kapandji procedure for old fracture of distal radius combined with distal ulna-radial joint dislocation in young adults.Methods From January 2008 to January 2014,7 cases of old fracture of distal radius combined with distal ulna-radial joint dislocation were treated with ulnar shortening and distal radioulnar joint fusion.Measures included wrist pain,wrist activity,wrist function and radiographic evaluation.Efficacy was assessed using Gartland-Werley wrist score.Results All patients were followed up for 18 to 70 months,with an average of(27.5±3.7)months.All incisions healed well without infection and other complications.Preoperative wrist VAS score was(4.8±1.7),postoperative VAS score of last follow-up was(2.3±1.1).Wrist extension before surgery was(15.3±2.1)degrees,postoperative(26.9±1.7)degrees.Wrist flexion before surgery was(18.5±2.7)degrees,postoperative(45.1±3.2)degrees.Pronation activity before surgery was(35.7±2.8)degrees,postoperative(71.3±2.1)degrees.Supination activity before surgery was(16.5±2.5)degrees,postoperative(41.3±3.5)degrees.Radiographic examination showed a positive variation of the distal ulna were not corrected for variations radioulnar joint integration firm,distal ulna pseudarthrosis showed no new bone formation.According to Gartland-Werley wrist functional scoring,the wrist functions were excellent in 3 cases,good in 3 cases and medium in 1 case,the excellent and good rate was 85.71%.Conclusion Ulnar shortening and distal radioulnar joint fusion is an effective and safe method for old fracture of distal radius combined with distal ulna-radial joint dislocation.This procedure not only retains the wrist ulnar bone support and maintain joint stability,but alleviated the wrist pain and improves forearm rotation.

关 键 词：桡骨骨折 下尺桡关节 脱位 腕关节功能 

分 类 号：R683.41[医药卫生—骨科学]