Seitz William H, Raikin Steven M
Department of Orthopaedic Surgery, Cleveland Clinic Lerner College of Medicine, Cleveland Orthopaedic and Spine Hospital at Lutheran, a Cleveland Clinic Hospital, OH 44113, USA.
Tech Hand Up Extrem Surg. 2007 Dec;11(4):224-30. doi: 10.1097/BTH.0b013e31805752f8.
Acute management of fractures involving the head and neck of the distal ulna associated with comminuted unstable fractures of the distal radius remains difficult and controversial. Fifteen consecutive such cases treated with combined external and internal fixation together with primary resection of comminuted distal ulna fracture fragments and reconstruction of the periosteal sleeve and triangular fibrocartilaginous complex are reviewed. At an average follow-up of 5.8 years, all patients were assessed for range of motion, strength, pain and function, and radiographic appearance. All had a range of motion postoperatively of at least 85% of the opposite wrist in all planes. Average grip strength was 88.6% of the contralateral wrist. Radiographic evaluation demonstrated no evidence of instability in any plane. There were no cases of subluxation of the distal ulna nor collapse of the ulnar side of the carpus. Those 7 patients studied arthrographically demonstrated an intact "water-tight" ulna-sided soft tissue sling, and all distal radius fractures healed primarily.
涉及尺骨远端头颈部的骨折与桡骨远端粉碎性不稳定骨折相关，其急性处理仍然困难且存在争议。本文回顾了连续15例采用外固定与内固定相结合的方法治疗的此类病例，同时对粉碎的尺骨远端骨折碎片进行一期切除，并重建骨膜袖和三角纤维软骨复合体。平均随访5.8年，对所有患者的活动范围、力量、疼痛和功能以及影像学表现进行了评估。所有患者术后各平面的活动范围均至少达到对侧腕关节的85%。平均握力为对侧腕关节的88.6%。影像学评估显示在任何平面均无不稳定迹象。没有尺骨远端半脱位或腕关节尺侧塌陷的病例。7例接受关节造影检查的患者显示尺骨侧软组织吊带完整且“水密”，所有桡骨远端骨折均一期愈合。
