尺骨茎突骨折分型与内固定对桡骨远端骨折术后腕关节功能及预后影响.docVIP

尺骨茎突骨折分型与内固定对桡骨远端骨折术后腕关节功能及预后影响 　　[摘要] 目的 探?尺骨茎突骨折分型与内固定对桡骨远端骨折术后的腕关节功能及预后的影响。 方法 选择2012年5月～2016年5月期间收治的120例合并尺骨茎突骨折的桡骨远端骨折患者为研究对象，随机分为A组和B组，各60例。A组对桡骨远端骨折行切开复位内固定后，对尺骨茎突骨折行内固定处理，而B组对尺骨茎突骨折无内固定操作。分析尺骨茎突骨折分型对腕关节功能及预后的影响。 结果 两组所有患者治疗后掌倾角、尺偏角、桡骨长度均较治疗前明显改善（P0.05）。治疗1年后，B组Ⅰ型与Ⅱ型之间、A组Ⅱ型与B组Ⅱ型之间，Gartland-Werley评分优良率对比，差异有统计学意义（P0.05）。B组Ⅱ型腕关节主动活动度各指标及握力水平均显著低于B组Ⅰ型及A组Ⅱ型（P0.05）。 结论 桡骨远端骨折合并Ⅰ型尺骨茎突骨折对术后腕关节功能无明显影响，可选择不进行内固定；而当合并Ⅱ型尺骨茎突骨折，对腕关节功能及预后有显著影响，应进行内固定治疗以促进腕关节功能恢复，改善预后。 　　[关键词] 尺骨茎突骨折；桡骨远端骨折；内固定；腕关节 　　[中图分类号] R683 [文献标识码] B [文章编号] 1673-9701（2018）09-0069-04 　　[Abstract] Objective To investigate the effect of ulnar styloid fracture classification and internal fixation on function and prognosis of wrist after distal radius fracture surgery. Methods A total of 120 patients with distal radius fractures combined with ulnar styloid fracture from May 2012 to May 2016 were selected and randomly divided into group A and group B （60 cases each）， group A took open reduction and internal fixation for the distal radius fractures and took internal fixation for ulnar styloid fractures， while group B took no fixation operation for ulnar styloid fracture. Analyzed effects of ulnar styloid fracture classification on function and prognosis of wrist. Results After treatment， all patients in both groups showed significant improvements in their palm tilt angle， ulnar drift angle and radius length compared with those before treatment（P0.05）. The difference of excellent rate of Gartland-Werley score was statistically significant（P0.05） between type Ⅰ and Ⅱ of group B， between type Ⅱ in group A and B 1 year after treatment. The indexes of active mobility and the grip strength of wrist in type Ⅱ of group B were significantly lower than type Ⅰ in group B and type Ⅱ in group A（P0.05）. Conclusion The distal radius fractures with type Ⅰ ulna styloid fractures have no significant effect on postoperative wrist function， so it can take no internal fixation. When combined with type Ⅱ ulna styloid fractu