桡骨远端骨折合并同侧腕舟骨骨折的临床特点与治疗策略  

Clinical characteristics and treatment strategies of distal radius fracture combined with ipsilateral scaphoid fracture

作　　者：张琳袁 吴佳俊 沈超 付备刚 崔崟 王秀会[1] 崔煦 Zhang Linyuan;Wu Jiajun;Shen Chao;Fu Beigang;Cui Yin;Wang Xiuhui;Cui Xu(Department of Orthopedics,Zhoupu Hospital Affiliated to Shanghai University of Medicine and Health Sciences,Shanghai 201318,China)

机构地区：[1]上海健康医学院附属周浦医院骨科,上海201318

出　　处：《中华手外科杂志》2023年第2期112-115,共4页Chinese Journal of Hand Surgery

基　　金：浦东新区卫健委临床特色学科项目(PWYts2021-03);上海市浦东新区卫生系统优秀青年医学人才培养计划(PWRq2020-41);上海市卫生健康委员会科研课题基金(20204Y0478)。

摘　　要：目的探讨桡骨远端骨折合并同侧腕舟骨骨折的临床特点与手术治疗效果。方法回顾性分析自2015年1月至2021年6月在我院行手术治疗的桡骨远端骨折合并同侧腕舟骨骨折患者13例。记录患者一般资料、骨折类型及手术相关指标;随访两处骨折愈合时间,记录并发症;末次随访测量患腕影像学参数:桡骨高度、掌倾角、尺偏角,采用DASH评分及Mayo评分评定患腕功能,并记录患腕与健侧腕关节活动范围。结果术后13例患者均获得随访,时间为12~30个月,平均(15.3±6.8)个月。所有患者桡骨远端及舟骨骨折均愈合,桡骨远端骨折平均愈合时间为(10.6±2.8)周,舟骨骨折平均愈合时间为(12.5±3.8)周,无延迟愈合、舟骨坏死、创伤性关节炎等并发症。末次随访,平均掌倾角为(8.8±5.2)°、尺偏角(17.2±6.6)°、桡骨高度(11.5±4.8)mm;患腕平均DASH评分为(12.3±5.4)分;根据Mayo评分标准:优9例,良3例,可1例。患腕平均掌屈角度(49.4±8.2)°小于健侧(57.6±7.4)°,差异有统计学意义(P<0.05);患腕背伸、尺偏、桡偏、旋前与旋后角度与健侧相比差异无统计学意义(P>0.05)。结论桡骨远端骨折合并同侧舟骨骨折发病率低,临床应注意鼻烟窝压痛症状及完善CT扫描,避免漏诊。一期掌侧接骨板内固定桡骨远端骨折与无头加压螺钉固定舟骨骨折,利于早期功能锻炼,获得良好的功能恢复。Objective To investigate the clinical characteristics and surgical treatment efficacy of distal radius fracture combined with ipsilateral scaphoid fracture.Methods Thirteen patients with distal radius fracture and ipsilateral scaphoid fracture who were operated in our hospital from January 2015 to June 2021 were analyzed retrospectively.The general data,fracture types and surgical related indexes of patients were recorded.The healing time of two fractures were followed up and the complications were recorded.At the last follow-up,the imaging parameters of the affected wrist were measured,including radius height,palmar inclination and ulnar deflection angle.The function of the affected wrist was evaluated with DASH score and Mayo score,and the range of motion of the affected wrist and the uninjured wrist were recorded.Results All the 13 patients were follow-up for 12 to 30 months with an average of(15.3±6.8)months.All the patients with distal radiusfractures and scaphoid fractures healed.The average healing time of distal radius fractures was(10.6±2.8)weeks,and the average healing time of scaphoid fractures was(12.5±3.8)weeks.There was no delayed healing,scaphoid necrosis,traumatic arthritis and other complications.At the last follow-up,the average palmar inclination was(8.8±5.2)°,ulnar declination was(17.2±6.6)°,and radius height was(11.5±4.8)mm.The average DASH score of affected wrist was(12.3±5.4)points.According to Mayo scoring standard,the results were excellent in 9 cases,good in 3 cases and fair in 1 case.The average palmar flexion angle of the affected wrist was(49.4±8.2)°less than that of the uninjured side(57.6±7.4)°,with a statistically significant difference(P<0.05).There was no significant difference in dorsal extension,ulnar deviation,radial deviation,pronation and supination angle between the affected wrist and the healthy side(P>0.05).Conclusion The incidence rate of distal radius fractures combined with ipsilateral scaphoid fractures is low.The clinical attention should be paid to the

关 键 词：骨折固定术 内 治疗结果 桡骨远端骨折 舟骨骨折 

分 类 号：R687.3[医药卫生—骨科学]