桡骨远端骨折合并尺骨茎突骨折内固定术后掌倾角和尺偏角改变对桡骨短缩的影响  

Effects of metacarpal inclination angle and ulnar deviation angle on radius length shortening after distal radius fracture combined with internal fixation of ulnar styloid fracture

作　　者：郭洋 刘凯 Guo Yang;Liu Kai(Department of Trauma,Beijing Daxing District People′s Hospital,Beijing 102600,China)

机构地区：[1]北京市大兴区人民医院创伤科,北京102600

出　　处：《国际外科学杂志》2023年第7期486-493,F0003,共9页International Journal of Surgery

摘　　要：目的探讨桡骨远端骨折合并尺骨茎突骨折内固定术后掌倾角和尺偏角改变对桡骨短缩的影响。方法采用回顾性病例对照研究的方法, 分析2018年2月—2022年1月北京市大兴区人民医院手术治疗的84例桡骨远端骨折合并尺骨茎突骨折患者的临床资料。根据尺骨茎突骨折是否手术固定分为两组:尺骨茎突骨折给予手术固定的18例患者为固定组, 尺骨茎突骨折未进行手术固定的66例患者为非固定组。比较两组患者的围手术期指标(手术时间、术中出血量、手术切口长度), 腕关节功能指标[Gartland-Werley评分、上肢功能(DASH)评分、前臂旋转、尺偏、掌屈、桡偏、背伸、握力]和并发症发生情况(骨不连、骨溶解、腕尺侧疼痛、内固定失效、下尺桡不稳、术后感染)。通过广义估计方程(GEE)分析两组患者的掌倾角、尺偏角及桡骨远端距离多时点变化情况。随访12个月, 依据末次随访时桡骨短缩距离是否≥4 mm, 将所有患者分为未短缩组(桡骨短缩距离<4 mm, n=61)和短缩组(桡骨短缩距离≥4 mm, n=23)。通过Logistic回归分析评价术后桡骨短缩的影响因素。结果与非固定组相比, 固定组患者的Gartland-Werley评分[(1.79±0.62)分比(4.65±0.97)分]、DASH评分[(16.43±4.71)分比(28.72±6.06)分]、并发症发生率(11.11%比39.40%)均明显较低, 前臂旋转角度[(81.29±6.60)°比(70.79±5.15)°]、尺偏角度[(21.36±2.35)°比(16.77±2.11)°]、掌屈角度[(45.84±2.80)°比(37.55±2.45)°]、背伸角度[(50.23±5.16)°比(40.65±3.58)°]均明显较大, 差异均具有统计学意义(P<0.05)。GEE分析评价结果显示, 治疗时间、治疗方案及两者的交互作用对掌倾角、尺偏角及桡骨远端距离有明显影响(P<0.05)。掌倾角改变、尺偏角改变是内固定术后桡骨短缩的独立影响因素(P<0.05)。结论在桡骨远端骨折合并尺骨茎突骨折的病例治疗中, 通过桡骨远端合并尺骨茎突内固Objective To investigate the effects of metacarpal inclination angle and ulnar deviation angle on radius length shortening after internal fixation of distal radius fracture combined with ulnar styloid fracture.Methods A retrospective case-control study was conducted to analyze the clinical data of 84 patients with distal radius fracture complicated with ulnar styloid fracture treated by Beijing Daxing District People′s Hospital from February 2018 to January 2022.According to whether the ulnar styloid fracture was fixed or not,the patients were divided into two groups:18 patients with ulnar styloid fractures who were surgically fixed were in the fixation group,and 66 patients with ulnar styloid fractures who were not surgically fixed were in the non-fixation group.The perioperative indexes(operation time,intraoperative blood loss,surgical incision length),wrist joint function indexes[Gartland-Werley score,disability of the arm,shoulder,and hand(DASH)score,forearm rotation,ulnar deviation,metacarpal flexion,radial deviation,dorsal extension,grip strength]and complications(bone nonunion,osteolysis,ulnar pain,internal fixation failure,lower ulnar and radial instability,postoperative infection)were compared between the two groups.The changes of metacarpal inclination angle,ulnar deviation angle and distal radius distance of the two groups were analyzed by generalized estimation equation(GEE).The patients were followed up for 12 months,they were divided into two groups:non-shortening group(radius shortening distance<4 mm,n=61)and radius shortening group(radius shortening distance≥4 mm,n=23)according to whether the radius shortening distance was≥4 mm at the last follow-up.The influencing factors of postoperative radius shortening were evaluated by Logistic regression analysis.Results Compared with the non-fixation group,the Gartland-Werley score(1.79±0.62 vs 4.65±0.97),DASH score(16.43±4.71 vs 28.72±6.06)and the incidence of complications(11.11%vs 39.40%)in the fixation group were significantly lower,and the f

关 键 词：桡骨骨折 尺骨骨折 骨折固定术 内 桡骨短缩 

分 类 号：R687.3[医药卫生—骨科学]