关节镜下辅助复位锚钉固定治疗尺骨茎突陈旧性骨折不愈合合并三角纤维软骨复合体损伤的疗效  

Efficacy of arthroscope‑assisted reduction and anchor fixation in the treatment of old ununited fractures of the ulnar styloid process combined with triangular fibrocartilage complex injury

作　　者：向往 杨顺[1] 程亚博[1] Xiang Wang;Yang Shun;Cheng Yabo(Department of Hand Surgery,Sichuan Provincial Orthopedic Hospital,Chengdu 610041,China)

机构地区：[1]四川省骨科医院手腕科,成都610041

出　　处：《中华创伤杂志》2024年第12期1100-1106,共7页Chinese Journal of Trauma

基　　金：四川省医学科研课题计划(S20056)。

摘　　要：目的探讨关节镜下辅助复位锚钉固定治疗尺骨茎突陈旧性骨折合不愈合合并三角纤维软骨复合体(TFCC)损伤的疗效。方法采用回顾性病例系列研究分析2018年6月至2023年6月四川省骨科医院收治的30例尺骨茎突陈旧性骨折不愈合合并TFCC损伤(存在腕尺侧压痛、握力减退)患者的临床资料,其中男18例,女12例;年龄40~54岁[(47.6±5.4)岁]。均为HauckⅡ型骨折。左侧17例,右侧13例。采用关节镜下辅助复位锚钉固定尺骨茎突,同时修复损伤的TFCC。比较术前和术后3、6个月及末次随访时腕尺侧视觉模拟评分(VAS)。术后1~6个月摄腕关节正、侧位X线片,观察骨折愈合情况。比较术前和术后3、6个月及末次随访时腕关节屈伸活动度、腕关节桡尺偏活动度、腕关节前臂旋转活动度、Cooney腕关节功能评分、握力。观察术中及术后并发症发生情况。结果患者均获随访12~16个月[(13.5±2.3)个月]。术后3、6个月及末次随访时腕尺侧VAS分别为(3.1±0.8)分、(1.4±0.8)分、(1.2±0.5)分,均低于术前的(7.1±0.8)分(P<0.05);术后6个月及末次随访时均低于术后3个月(P<0.05);术后6个月与末次随访时差异无统计学意义(P>0.05)。术后28例患者骨折愈合良好,愈合时间为3~4个月[(3.0±1.3)个月],2例患者骨折未愈合。术前和术后3、6个月及末次随访时腕关节屈伸活动度、腕关节桡尺偏活动度差异均无统计学意义(P>0.05)。术后3、6个月及末次随访时腕关节前臂旋转活动度分别为(149.9±10.8)°、(158.6±10.5)°、(159.0±11.1)°,均大于术前的(131.7±11.0)°(P<0.05);术后6个月及末次随访时均大于术后3个月(P<0.05);术后6个月与末次随访时差异无统计学意义(P>0.05)。术后3、6个月及末次随访时Cooney腕关节功能评分分别为(51.7±5.8)分、(74.8±6.2)分、(84.3±6.6)分,均高于术前的(39.8±6.1)分(P<0.05),且术后各时间点评分逐渐增高(P<0.05)。末次随访时根据Cooney�Objective To investigate the efficacy of arthroscope‑assisted reduction and anchor fixation in the treatment of old ununited fractures of the ulnar styloid process combined with triangular fibrocartilage complex(TFCC)injury.Methods A retrospective case series study was conducted to analyze the clinical data of 30 patients with old ununited fractures of the ulnar styloid process combined with TFCC injury(with pressing pain of the ulnar wrist and decreased grip strength)admitted to Sichuan Provincial Orthopedic Hospital from June 2018 to June 2023,including 18 males and 12 females,aged 40‑54 years[(47.6±5.4)years].All the patients had Hauck type II fractures.A total number of 17 patients had fractures on the left side and 13 on the right side.Arthroscope‑assisted reduction and anchor fixation of the ulnar styloid process were performed and the injured TFCC was repaired simultaneously.The visual analogue scale(VAS)scores for ulnar‑sided wrist pain before surgery,at 3 and 6 months after surgery,and at the last follow‑up were compared.Anteroposterior and lateral X‑rays of the wrist joint were taken at 1‑6 months after surgery to observe the fracture healing.The ranges of motion of wrist flexion and extension,wrist radial‑ulnar deviation,and forearm rotation,Cooney wrist function scores,and grip strengths before surgery,at 3 and 6 months after surgery,and at the last follow‑up were compared.The occurrence of intraoperative and postoperative complications was observed.Results All the patients were followed up for 12‑16 months[(13.5±2.3)months].At 3,6 months after surgery and at the last follow‑up,the VAS scores for ulnar‑sided wrist pain were(3.1±0.8)points,(1.4±0.8)points,and(1.2±0.5)points respectively,which were all lower than(7.1±0.8)points before surgery(P<0.05).The VAS scores at 6 months after surgery and at the last follow‑up were lower than that at 3 months after surgery(P<0.05),while there were no significant difference between the scores at 6 months after surgery and at the last

关 键 词：尺骨 骨折 不愈合 关节镜 

分 类 号：R687.3[医药卫生—骨科学]