【摘要】 目的 研究C型桡骨远端骨折合并Ⅱ型(Hauck分型)尺骨茎突基底骨折时，克氏针张力带技术切开复位内固定治疗尺骨茎突骨折对桡骨远端骨折内固定术后腕关节功能的影响。方法 回顾性分析2018年1月—2021年6月哈尔滨市第五医院骨科收治的87例C型桡骨远端骨折同时合并Ⅱ型尺骨茎突基底骨折患者资料，男性32例，女性55例；年龄28～68岁，平均56.3岁；摔伤40例，高处坠落伤47例。根据尺骨茎突骨折是否固定分为固定组(46例)、对照组(41例),桡骨远端骨折均采用Henry入路切开复位掌侧锁定接骨板内固定，固定组行尺骨茎突切开复位克氏针张力带内固定，对照组给予前臂旋后位经皮自尺骨向桡骨克氏针间接固定。术后1d及1、3、12个月分别记录患者患肢功能参数(掌屈、背伸、旋前、旋后)、手指总主动活动度(total active motion, TAM)及视觉模拟评分(visual analogue scale, VAS),定期复查腕部X线片评估骨折愈合情况，记录骨折愈合时间。末次随访记录患肢腕尺侧疼痛发生率，关节功能评价使用Gartland-Werley功能评分、上肢功能(disability of arm, shoulder and hand, DASH)评分评定患肢功能。结果 术后患者均获随访，随访时间13～26个月，平均16.4个月。两组桡骨远端骨折均达骨性愈合，骨折愈合时间比较差异无统计学意义。固定组尺骨茎突均骨性愈合，无畸形愈合或不愈合发生；对照组骨性愈合24例(其中畸形愈合14例),不愈合17例。术后1d、1个月，固定组患肢功能参数(掌屈、背伸、旋前、旋后)均明显优于对照组(P<0.05);术后3个月，固定组掌屈角度明显大于对照组(P<0.05),背伸角度及手指TAM比较差异无统计学意义；术后12个月，两组患者掌屈角度及手指TAM比较差异无统计学意义；术后所有时间节点旋后角度固定组均明显大于对照组(P<0.05);术后1d固定组VAS高于对照组，此后的时间节点固定组VAS均低于对照组，但差异无统计学意义(P>0.05);末次随访显示固定组尺侧旋转疼痛发生率(15.2%,7/46)明显低于对照组(51.2%,21/41,P<0.05),Gartland-Werley评分、DASH评分均优于对照组(P<0.05)。结论 对于合并尺骨茎突基底骨折的C型桡骨远端骨折，尺骨茎突骨折切开复位内固定能够明显提高桡骨远端C型骨折术后腕关节功能，降低尺骨茎突畸形愈合、不愈合发生率。更多还原

【Abstract】 Objective To investigate whether K-wire tension band fixation of the fractured ulnar styloid can improve the wrist functions following internal fixation of type C distal radius fracture combined with type-II(Hauck classification) ulnar styloid fracture(USF). Methods A total of 87 patients with type C distal radius fractures combined with type II USF and admitted to our hospital from Jan. 2018 to Jun. 2021 were retrospectively analyzed. There were 32 males and 55 females, with an average age of 56.3 years(28-68 years),including 40 cases due to ground-level falls and 47 to falls from height. Based on whether the USF was fixed, patients were divided into fixation group(46 cases) and control group(41 cases). All the distal radius fractures were treated via volar Henry approach(open reduction and volar fixation by locking plate). In the fixation group, the fractured ulnar styloid received open reduction and K-wire tension band fixation, while in the control group, the fractured ulnar styloid only received forearm supination and indirect fixation using a K-wire from the ulna to the radius. Functional parameters of the affected limb like palmar flexion, dorsalis extension, pronation and supination, total active motion(TAM) of the fingers, and visual analogue scale(VAS) were recorded at 1 d, 1,3 and 12 months after surgery. Wrist radiographs were obtained periodically to evaluate the fracture healing and the union time. The incidence of ulnar carpal pain was recorded at the last follow-up. The Gartland-Werley score and disability of the arm, shoulder and hand(DASH) score were used to evaluate the function of the affected limb.Results All patients were followed up for 13-26 months, mean 16.4 months. The DRF achieved union in both groups, revealing no significant difference regarding the union time. For the USF,the fixation group achieved full union of all cases without malunion or nonunion, while the control group showed union in 24 cases(including 14 cases of malunion) and nonunion in 17 cases. Compared with the control group, the fixation group showed(1) much better functional parameters(palmar flexion, dorsalis extension, pronation, and supination) of the affected limb at 1 d and 1 month after surgery(all P<0.05),(2) much larger palmar flexion(P<0.05) and similar dorsalis extension and finger TAM at 3 months,(3) similar palmar flexion and finger TAM at 12 months,(4) much better supination at all time points, and(5) much higher VAS score on 1 d after surgery(P<0.05) and lower VAS at subsequent time points without significant difference(all P>0.05). At the last follow-up, the fixation group also revealed a much lower incidence of ulnar rotation pain(15.2% vs. 51.2%) and ulnar pain, and much better Gartland-Werley scores and DASH scores(all P<0.05). Conclusion For type C distal radius fractures combined with USF,open reduction and K-wire tension band fixation of the fractured ulnar styloid can significantly improve the wrist joint functions and reduce the incidence of malunion and nonunion.更多还原