尺骨节段截骨内固定治疗老年桡骨远端陈旧性骨折后畸形及并发症的临床研究  

Clinical study of ulnar segmental osteotomy and internal fixation in the treatment of old distal radius fractures with dislocation of the distal ulnar-radial joint in the elderly

作　　者：欧阳振[1] 卫永鲲[1] 尹伟[1] 徐琳[1] OUyang Zhen;WEI Yongkun;YIN Wei(Department of Orthopedics,The Affiliated 3201 Hospital to Medical College of Xi'an Jiaotong University,Hanzhong,Shanxi,723000,China)

机构地区：[1]西安交通大学医学院附属3201医院骨科,陕西汉中723000

出　　处：《实用手外科杂志》2020年第4期384-386,404,共4页Journal of Practical Hand Surgery

摘　　要：目的探讨尺骨节段截骨内固定治疗桡骨远端陈旧性骨折并下尺桡关节脱位的临床效果。方法对2017年1月-2019年12月收治的22例桡骨远端陈旧性骨折的老年患者,均采用尺骨节段截骨钢板内固定治疗,术后采用VAS、改良的Gartlandand Werley腕关节功能评分系统评价治疗效果。结果22例均获得随访,随访时间3~30个月,平均12.5个月。所有患者截骨全部愈合,无内固定失效、伤口感染及骨不连等并发症。治疗后患者VAS评分均较入院时明显下降(P<0.05),所有病例腕关节的掌屈、背伸、尺桡偏及前臂旋前、旋后功能均明显改善(P<0.05),末次随访按改良的Gartlandand Werley腕关节功能评价:优14例,良6例,可1例,差1例,优良率90.9%。结论尺骨节段性截骨有效减轻尺骨过长引起的尺侧撞击痛,维持前臂的旋转功能,是治疗陈旧性桡骨远端骨折引起下尺桡关节脱位一种有效的手术方法。Objective To investigate the clinical effect of ulnar segmental osteotomy and internal fixation in the treatment of old fractures of the distal radius with dislocation of the distal ulna and radius joint.Methods From January 2017 to December 2019,22 elderly patients with old distal radius fractures were treated.All patients were treated with segmental ulna osteotomy and internal fixation.The results were evaluated by Vas,improved Gartland and Werley wrist function score system.Results All 22 patients were followed up for 3-30 months with an average of 12.5 months.All the osteotomies healed without any complications such as failure of internal fixation,wound infection and nonunion.After treatment,the VAS score of the patients was significantly lower than that at admission(P<0.05),the wrist flexion,extension,radioulnar deviation and forearm pronation and supination function were significantly improved in all cases(P<0.05),the wrist function was evaluated by improved Gartland and Werley during the last follow-up:Excellent in 14 cases,good in 6 cases,fair in 1 case,poor in 1 case,excellent and good rate was 90.9%.Conclusion Segmental osteotomy of ulna effectively alleviates the pain of Ulnar impact caused by excessive length of ulna and maintains forearm rotation,it is an effective surgical method for the treatment of dislocation of the distal ulnar-radial joint caused by old distal radial fracture.

关 键 词：桡骨远端陈旧性骨折 下尺桡关节脱位 尺骨节段截骨 

分 类 号：R687.3[医药卫生—骨科学]