Souer J Sebastiaan, Ring David, Matschke Stefan, Audige Laurent, Marent-Huber Marta, Jupiter Jesse B
Massachusetts General Hospital, Yawkey Center, Suite 2100, 55 Fruit Street, Boston, MA 02114, USA.
J Bone Joint Surg Am. 2009 Apr;91(4):830-8. doi: 10.2106/JBJS.H.00345.
The impact of an unrepaired fracture of the ulnar styloid base on recovery after internal fixation of a fracture of the distal part of the radius is uncertain. We evaluated a series of patients with an internally fixed fracture of the distal part of the radius to test the hypothesis that there is no difference in wrist motion or function scores between those with an untreated fracture of the ulnar styloid base and those with no ulnar fracture.
Two cohorts of seventy-six matched patients, one with a fracture of the ulnar styloid base and the other with no ulnar fracture, were retrospectively analyzed by examining data gathered in a prospective study of plate-and-screw fixation of distal radial fractures. Patients were matched for age, sex, AO fracture type, and injury mechanism. The two cohorts were analyzed for differences in motion, grip strength, pain, the Gartland and Werley score, the DASH (Disabilities of the Arm, Shoulder and Hand) score, and the SF-36 (Short Form-36) score at six, twelve, and twenty-four months postoperatively. In a second analysis, sixty-four patients with <2 mm of displacement of a fracture of the ulnar styloid base were compared with forty-nine patients with greater displacement. Differences between cohorts and within cohorts over time were determined with use of regression analysis and the likelihood ratio test.
No significant differences were found between patients with an unrepaired fracture of the ulnar styloid base and those with no ulnar fracture at any of the follow-up intervals. However, a trend was observed toward less grip strength at six months (71% [of that on the contralateral side] compared with 79%; mean difference, -8% [95% confidence interval=-15.3% to -0.6%]; p=0.03) and less flexion (54 degrees compared with 59 degrees ; mean difference, -5 degrees [95% confidence interval=-11.7 degrees to -0.8 degrees ]; p=0.02) and ulnar deviation (32 degrees compared with 36 degrees ; mean difference, -4 degrees [95% confidence interval=-7 degrees to -0.1 degrees ]; p=0.05) at twenty-four months after surgery in patients with an untreated fracture of the ulnar styloid base. There were no significant differences with regard to any tested outcome measure between the patients with >or=2 mm of displacement of an unrepaired fracture of the ulnar styloid base and those with less displacement.
An unrepaired fracture of the base of the ulnar styloid does not appear to influence function or outcome after treatment of a distal radial fracture with plate-and-screw fixation, even when the ulnar fracture was initially displaced >or=2 mm.
尺骨茎突基底未修复骨折对桡骨远端骨折内固定术后恢复的影响尚不确定。我们评估了一系列桡骨远端骨折内固定患者，以检验以下假设：尺骨茎突基底骨折未治疗患者与无尺骨骨折患者在腕关节活动度或功能评分方面无差异。
对两组各76例匹配患者进行回顾性分析，一组有尺骨茎突基底骨折，另一组无尺骨骨折，分析的数据来自一项关于桡骨远端骨折钢板螺钉固定的前瞻性研究。根据年龄、性别、AO骨折类型和损伤机制对患者进行匹配。对两组患者术后6个月、12个月和24个月时的活动度、握力、疼痛、Gartland和Werley评分、DASH（上肢、肩部和手部功能障碍）评分以及SF - 36（简明健康状况调查量表）评分的差异进行分析。在第二项分析中，将64例尺骨茎突基底骨折移位<2 mm的患者与49例移位较大的患者进行比较。采用回归分析和似然比检验确定组间及组内随时间的差异。
在任何随访期间，尺骨茎突基底骨折未修复患者与无尺骨骨折患者之间均未发现显著差异。然而，观察到一种趋势，即尺骨茎突基底骨折未治疗患者在术后6个月时握力较低（患侧为对侧的71%，而对侧为79%；平均差异为 - 8% [95%置信区间 = - 15.3%至 - 0.6%]；p = 0.03），在术后24个月时屈曲度较小（54度对比59度；平均差异为 - 5度 [95%置信区间 = - 11.7度至 - 0.8度]；p = 0.02）以及尺偏度较小（32度对比36度；平均差异为 - 4度 [95%置信区间 = - 7度至 - 0.1度]；p = 0.05）。尺骨茎突基底骨折未修复且移位≥2 mm的患者与移位较小的患者在任何测试结果指标方面均无显著差异。
尺骨茎突基底未修复骨折似乎不影响桡骨远端骨折钢板螺钉固定治疗后的功能或预后，即使尺骨骨折最初移位≥2 mm。
