Nakanishi Yasuaki, Omokawa Shohei, Shimizu Takamasa, Nakano Kenichi, Kira Tsutomu, Tanaka Yasuhito
Department of Orthopedic Surgery, Nara Medical University, Kashihara, Nara, 634-8522, Japan,
J Orthop Sci. 2013 Sep;18(5):788-92. doi: 10.1007/s00776-013-0407-0. Epub 2013 Jun 8.
The purpose of this study was to analyze fracture patterns and the magnitude of displacement in the distal radioulnar joint (DRUJ), by three-dimensional (3D) computed tomography (CT), for distal radius fractures with intra-articular displacement of the radiocarpal joint.
We reconstructed 3D images for 72 consecutive patients with displaced intra-articular distal radius fracture on the basis of fine-cut axial CT data. The fracture patterns involving the DRUJ were classified on the basis of the location and direction of fracture lines, and the extent of fracture comminution. We measured the maximum spatial distance of the gap and the step between the fragments in each 3D image, and the magnitudes of displacement between the groups were compared by analysis of variance followed by post-hoc analysis by use of Tukey's test.
Sixty wrists had a fracture involving the DRUJ. We classified the 60 wrists into 3 types of fracture pattern. Type 1 was a transverse fracture with minimum displacement. Type 2, in which fracture lines extended into the distal margin of the sigmoid notch, was the most common longitudinal fracture. Type 3 was a fracture with multiple fragments. The step and gap in Type 3 was significantly larger than that in the other types.
Eighty-three percent of intra-articular distal radius fractures had DRUJ involvement, and 28% of the wrists had multiple fragments. For Type 3 fractures with dorsal or proximal comminution displacement was significantly larger than for simple Type 1 and 2 fractures. Surgical intervention for the DRUJ fragment may be beneficial when there is remarkable intra-articular displacement.
本研究旨在通过三维（3D）计算机断层扫描（CT）分析桡腕关节内移位的桡骨远端骨折时尺桡远侧关节（DRUJ）的骨折类型及移位程度。
我们基于薄层轴向CT数据为72例连续性桡骨远端关节内移位骨折患者重建了3D图像。根据骨折线的位置和方向以及骨折粉碎程度对累及DRUJ的骨折类型进行分类。我们在每张3D图像上测量骨折块之间间隙的最大空间距离和台阶，并通过方差分析比较各组之间的移位程度，随后使用Tukey检验进行事后分析。
60例腕关节发生了累及DRUJ的骨折。我们将这60例腕关节分为3种骨折类型。1型为移位最小的横行骨折。2型是骨折线延伸至乙状切迹远侧边缘的最常见的纵行骨折。3型为多块骨折。3型的台阶和间隙明显大于其他类型。
83%的桡骨远端关节内骨折累及DRUJ，28%的腕关节有多个骨折块。对于伴有背侧或近端粉碎的3型骨折，移位明显大于简单的1型和2型骨折。当关节内移位明显时，对DRUJ骨折块进行手术干预可能有益。
