Liu Jie, Li Shao-hua, Cai Zheng-dong, Li Zhen-hua, Wang Jian-guang, Zhang Lei, Yu Lei
Department of Orthopaedics, the Tenth People's Hospital of Shanghai, Tongi University, Trauma and Emergency Center of Shanghai, Shanghai, 200072, China.
Zhongguo Gu Shang. 2011 Nov;24(11):890-3.
To explore the options on treatment of distal radioulnar joint instability combined with distal radius fracture.
From June 2007 to December 2009, 264 patients with unstable distal radius fractures were treated with open reduction and internal fixation, in which 42 patients combined with distal radioulnar instability. Distal radioulnar joints of 20 patients were fixed with Kirschner wire or plaster cast at supinator position, and other distal radioulnar joints of 22 patients were not fixed. Range of motion of wrist joints and grip strength were observed; function of wrist were evaluated by modified Gartland-Werley scoring system (GW score); stability of distal radioulnar joints were tested at final follow-up.
Forty-one patients were followed up more than 1 year. All fractures obtained healing within 3 months after operation, and apposition of joints was good, no significant subluxation or dislocation were found. There were not statistical differences in grip strength, motion of joints and GW score between two groups (fixation and non-fixation). Only one patient occurred chronic distal radioulnar instability.
There was no significant difference between fixation and non fixation for the treatment of distal radius fractures with distal radioulnar joint instability. For this reason, if fractures can be satisfactory reduced, there is no need for the one-stage distal radioulnar joint fixation.
探讨桡尺远侧关节不稳定合并桡骨远端骨折的治疗方法。
2007年6月至2009年12月，264例桡骨远端不稳定骨折患者行切开复位内固定治疗，其中42例合并桡尺远侧关节不稳定。20例患者的桡尺远侧关节采用克氏针或旋后位石膏固定，22例患者的桡尺远侧关节未固定。观察腕关节活动度和握力；采用改良Gartland-Werley评分系统（GW评分）评估腕关节功能；末次随访时检测桡尺远侧关节稳定性。
41例患者获随访1年以上。所有骨折均在术后3个月内愈合，关节对位良好，未发现明显半脱位或脱位。两组（固定组和非固定组）在握力、关节活动度和GW评分方面无统计学差异。仅1例患者出现慢性桡尺远侧关节不稳定。
桡尺远侧关节不稳定的桡骨远端骨折，固定与不固定治疗效果无明显差异。因此，若骨折能满意复位，则无需一期固定桡尺远侧关节。
