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[1]馬 遠(yuǎn).切開復(fù)位克氏針張力帶內(nèi)固定治療Hauck Ⅱ 型尺骨莖突骨折[J].中醫(yī)正骨,2019,31(11):12-16.
　MA Yuan.Open reduction and internal fixation with Kirschner wire and tension band for treatment of Hauck typeⅡulnar styloid fractures[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2019,31(11):12-16.
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切開復(fù)位克氏針張力帶內(nèi)固定治療Hauck Ⅱ 型尺骨莖突骨折()
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《中醫(yī)正骨》[ISSN:1001-6015/CN:41-1162/R]

卷:
第31卷
期數(shù):
2019年11期
頁碼:
12-16
欄目:
臨床研究
出版日期:
2019-11-20

文章信息/Info

Title:
Open reduction and internal fixation with Kirschner wire and tension band for treatment of Hauck typeⅡulnar styloid fractures
作者:
馬 遠(yuǎn)
(南陽市中心醫(yī)院,河南 南陽 473003)
Author(s):
MA Yuan
Nanyang Central Hospital,Nanyang 473003,Henan,China
關(guān)鍵詞:
尺骨骨折;  骨折固定術(shù); 內(nèi);  尺骨莖突
Keywords:
ulna fractures;  fracture fixation; internal;  styloid process of ulna
摘要:
目的:探討切開復(fù)位克氏針張力帶內(nèi)固定治療HauckⅡ型尺骨莖突骨折的臨床療效和安全性。方法:對(duì)2015年1月至2018年6月采用切開復(fù)位克氏針張力帶內(nèi)固定治療和未作處理的132例HauckⅡ型尺骨莖突骨折患者的病例資料進(jìn)行回顧性對(duì)比分析。男60例,女72例; 年齡24～78歲,中位數(shù)48歲; 均合并橈骨遠(yuǎn)端骨折; 受傷至手術(shù)時(shí)間3～12 d,中位數(shù)5 d。橈骨遠(yuǎn)端骨折均采用切開復(fù)位鋼板內(nèi)固定治療,尺骨莖突骨折采用切開復(fù)位克氏針張力帶內(nèi)固定治療或不作處理。分析骨折愈合、腕關(guān)節(jié)旋轉(zhuǎn)疼痛緩解、腕關(guān)節(jié)功能恢復(fù)及并發(fā)癥發(fā)生情況。結(jié)果:132例患者,尺骨莖突骨折采用切開復(fù)位克氏針張力帶內(nèi)固定治療58例(克氏針張力帶組),尺骨莖突骨折未作處理74例(未處理組)。患者均獲隨訪,隨訪時(shí)間12～36個(gè)月,中位數(shù)16個(gè)月。切口均甲級(jí)愈合; 橈骨遠(yuǎn)端骨折均骨性愈合,愈合時(shí)間3～6個(gè)月,中位數(shù)4個(gè)月。術(shù)后12個(gè)月時(shí),克氏針張力帶組尺骨莖突骨折愈合53例,患腕旋轉(zhuǎn)無痛40例,腕關(guān)節(jié)Mayo評(píng)分(90.47±5.35)分,腕關(guān)節(jié)功能評(píng)價(jià)優(yōu)28例、良26例、可4例; 未處理組尺骨莖突骨折愈合48例,患腕旋轉(zhuǎn)無痛28例,腕關(guān)節(jié)Mayo評(píng)分(85.22±7.92)分,腕關(guān)節(jié)功能評(píng)價(jià)優(yōu)26例、良34例、可12例、差2例; 克氏針張力帶組尺骨莖突骨折愈合率、患腕旋轉(zhuǎn)疼痛緩解率、腕關(guān)節(jié)Mayo評(píng)分均高于未處理組(χ2=12.721,P=0.000; χ2=11.555,P=0.001; t=4.331,P=0.000),腕關(guān)節(jié)功能評(píng)價(jià)結(jié)果優(yōu)于未處理組(Z=-1.900,P=0.047)。克氏針張力帶組發(fā)生克氏針退針3例,未出現(xiàn)腕關(guān)節(jié)旋轉(zhuǎn)疼痛癥狀,未行特殊處理; 均未發(fā)生切口感染、螺釘松動(dòng)、骨折復(fù)位丟失及神經(jīng)、血管損傷等并發(fā)癥。結(jié)論:切開復(fù)位克氏針張力帶內(nèi)固定治療HauckⅡ型尺骨莖突骨折,并發(fā)癥少,與不作處理比較,更有利于骨折愈合、患腕疼痛緩解及腕關(guān)節(jié)功能的恢復(fù)。
Abstract:
Objective:To explore the clinical curative effects and the safety of open reduction and internal fixation with Kirschner wire and tension band for treatment of Hauck typeⅡulnar styloid fractures.Methods:The medical records of 132 patients with Hauck typeⅡulnar styloid fractures who were untreated with any therapy or treated with open reduction and internal fixation with Kirschner wire and tension band from January 2015 to June 2018 were analyzed retrospectively.The patients consisted of 60 males and 72 females and ranged in age from 24 to 78 years(Median=48 yrs)and ranged in disease course from 3 to 12 days(Median=5 days).All of the 132 patients were diagnosed as ulnar styloid fracture combined with distal radius fracture.The distal radius fractures were treated with open reduction and plate internal fixation,while the ulnar styloid fractures were untreated or treated with open reduction and internal fixation with Kirschner wire and tension band.The fracture healing,wrist rotation pain relief,wrist function recovery and complications were analyzed respectively.Results:Fifty-eight out of 132 patients with ulnar styloid fractures were treated with open reduction and internal fixation with Kirschner wire and tension band(Kirschner wire and tension band group),while the other 74 patients were untreated with any therapy(non-treatment group).All patients in the 2 groups were followed up for 12-36 months with a median of 16 months.All patients got primary operative incision healing and bone union of distal radius fractures.The distal radius fracture healing time ranged from 3 to 6 months with a median of 4 months.At 12 months after the treatment,the ulnar styloid fracture healed in 53 patients in Kirschner wire and tension band group and 48 patients in non-treatment group,and painless rotation of wrist was found in 40 patients in Kirschner wire and tension band group and 28 patients in non-treatment group.The Mayo wrist scores were 90.47+/-5.35 points in Kirschner wire and tension band group and 85.22+/-7.92 points in non-treatment group.The wrist function evaluation results showed that 28 patients obtained an excellent result,26 good and 4 fair in Kirschner wire and tension band group; while 26 patients obtained an excellent result,34 good,12 fair and 2 poor in non-treatment group.The ulnar styloid fracture healing rate,affected wrist rotation pain relief rate and Mayo wrist scores were higher in Kirschner wire and tension band group compared to non-treatment group(χ2=12.721,P=0.000; χ2=11.555,P=0.001; t=4.331,P=0.000),and Kirschner wire and tension band group surpassed non-treatment group in the function evaluation results of affected wrist(Z=-1.900,P=0.047).The Kirschner wire withdrawal was found in 3 patients in Kirschner wire and tension band group,and no rotation pain were found in wrists,so no special treatment was performed.No complications such as incision infection,screw loosening,fracture reduction loss and damage of nerve or blood vessel were found in the 2 groups.Conclusion:Open reduction and internal fixation with Kirschner wire and tension band is more conducive to fracture healing,affected wrist pain relief and function recovery with less complications in treatment of Hauck typeⅡulnar styloid fractures as compared with non-treatment.

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(收稿日期:2019-08-28 本文編輯:楊雅)
更新日期/Last Update: 2019-11-10