尺骨头干骺端截骨与尺骨干截骨内固定治疗尺腕撞击综合征的疗效分析  

Clinical efficacy analysis of ulnar head metaphyseal osteotomy and ulnar shaft osteotomy with internal fixation in the treatment of ulnocarpal impaction syndrome

作　　者：张波[1] 魏蓝 赵振国[1] 徐宝强 张磊[1] 栗威[1] 韩清銮[1] Zhang Bo;Wei Lan;Zhao Zhenguo;Xu Baoqiang;Zhang Lei;Li Wei;Han Qingluan(Department of Hand and Foot Surgery,Affiliated Hospital of Jining Medical College,Jining 272029,China;Department of Outpatient,Affiliated Hospital of Jining Medical College,Jining 272029,China)

机构地区：[1]济宁医学院附属医院手足外科,济宁272029 [2]济宁医学院附属医院门诊部,济宁272029

出　　处：《中华手外科杂志》2024年第1期48-52,共5页Chinese Journal of Hand Surgery

基　　金：济宁医学院教师科研扶持基金(JYFC2019FKJ005)。

摘　　要：目的探讨采用尺骨头干骺端截骨空心钉内固定与尺骨干截骨钢板内固定治疗尺腕撞击综合征的疗效。方法自2015年2月至2021年8月我科收治尺腕撞击综合征患者34例。按手术方式分为二组:干骺端截骨组(采用尺骨头干骺端截骨空心钉内固定)18例,尺骨干截骨组(采用尺骨干截骨钢板内固定)16例。记录并比较两组手术时间、出血量、骨折愈合时间、术后尺骨变异值及骨折不愈合率;采用改良Mayo腕关节评分、视觉模拟评分(VAS)和上肢功能评价表(DASH)评分评价两种截骨内固定方式疗效。结果干骺端截骨组与尺骨干截骨组术前一般资料比较差异无统计学意义(P>0.05),具有可比性,术后患者均获得随访。干骺端截骨组手术时间为(36.36±6.53)min,出血量为(13.35±5.89)ml,随访时间为(13.05±1.06)个月,骨折愈合时间为(9.45±1.56)周,术后尺骨变异值为(-1.8±0.5)mm,骨折不愈合发生率为0(无骨折不愈合0/18);改良Mayo腕关节评分、VAS和DASH评分分别为(85.6±4.3)分、(1.7±1.3)分和(25.0±17.0)分。尺骨干截骨组手术时间为(87.35±5.26)min,出血量为(35.25±4.36)ml,随访时间为(14.05±1.33)个月,骨折平均愈合时间为(12.55±2.34)周,术后尺骨变异值为(-2.2±0.4)mm,骨折不愈合发生率为6.25%(1例患者骨折不愈合1/16);改良Mayo腕关节评分、VAS和DASH评分分别为(81.3±5.5)分、(1.8±1.2)分和(24.0±19.0)分。两种截骨内固定方式比较:两组在手术时间、出血量、骨折愈合时间、骨折不愈合发生率方面比较有明显差异,差异有统计学意义(P<0.05)。在随访时间、术后尺骨变异值、Mayo评分、VAS和DASH评分方面无明显差异,差异无统计学意义(P>0.05)。结论尺骨头干骺端截骨空心钉内固定较尺骨干截骨钢板内固定治疗尺腕撞击综合征,具有手术时间短、出血量少、骨折愈合时间短、骨折不愈合率低等优点,值得推荐应用;在腕关节功能评分恢复方面,�Objective To investigate the clinical efficacy of ulnar head metaphseal shortening osteotomy by hollow nail internal fixation and ulnar shaft shortening osteotomy by plate internal fixation in the treatment of ulnocarpal impaction syndrome.Methods From February 2015 to August 2021,34 patients with ulnocarpal impaction syndrome were treated.They were divided into two groups according to surgical methods:the metaphyseal osteotomy group(using hollow screws for internal fixation of the ulnar head metaphyseal osteotomy)with 18 cases,and the ulnar shaft osteotomy group(using plate for internal fixation of ulnar shaft osteotomy)with 16 cases.The surgical time,bleeding volume,fracture healing time,postoperative ulnar variation,and fracture nonunion rate between the two groups were recorded and compared.The modified Mayo wrist joint score,visual analogue scale(VAS),and upper limb function evaluation scale(DASH)were used to evaluate the efficacy of two osteotomy internal fixation methods.Results There was no statistically significant difference in preoperative general information between the metaphyseal osteotomy group and the ulnar shaft osteotomy group(P>0.05),indicating comparability.All postoperative patients were followed up.The surgical time of the metaphyseal osteotomy group was(36.36±6.53)minutes,the bleeding volume was(13.35±5.89)ml,the follow-up time was(13.05±1.06)months,the fracture healing time was(9.45±1.56)weeks,the postoperative ulnar variation value was(-1.8±0.5)mm,and the incidence of fracture nonunion was 0.The modified Mayo wrist joint score,VAS,and DASH scores were(85.6±4.30),(1.7±1.3),and(25.0±17.0),respectively.The surgical time of the ulnar shaft osteotomy group was(87.35±5.26)minutes,the bleeding volume was(35.25±4.36)ml,and the follow-up time was(14.05±1.33)months.The average fracture healing time was(12.55±2.34)weeks,and the postoperative ulnar variation value was(-2.2±0.4)mm.The incidence of fracture nonunion was 6.25%(1 patient had fracture nonunion,1/16).The modified Mayo wrist jo

关 键 词：尺骨 截骨术 尺腕撞击综合征 内固定 

分 类 号：R687.4[医药卫生—骨科学]