Chen Alvin Chao-Yu, Chiu Chih-Hao, Weng Chun-Jui, Chang Shih-Sheng, Cheng Chun-Ying
Bone and Joint Research Center, Department of Orthopaedic Surgery, Chang Gung Memorial Hospital-Linkou and Chang Gung University College of Medicine, 5th, Fu-Shin Street, Kweishan District, Taoyuan, 333, Taiwan, Republic of China.
J Orthop Surg Res. 2018 Jul 31;13(1):193. doi: 10.1186/s13018-018-0899-6.
The role of surgical fixation of ulnar styloid fractures remains a subject of debate. The purpose of this study was to compare the surgical outcomes following early and late intervention.
We retrospectively reviewed 28 patients who underwent surgical repair for unilateral ulnar styloid fractures with distal radioulnar instability between 2004 and 2014. Surgical fixation was performed within 3 months of injury in 13 patients (group A) and beyond 3 months in 15 patients (group B). Patient characteristics and functional outcomes were compared between the two groups. The outcome survey consisted of QuickDASH score, grip strength, range of motion, pain score based on the visual analog scale, and surgical complications. Descriptive statistics were calculated for key variables. A p value of < 0.01 was considered statistically significant.
Patient characteristics including age, sex, injured side, dominant side injury, and concomitant distal radius fracture showed no significant differences between the two groups. Time to surgery averaged 1.1 months in group A and 12.3 months in group B. Significantly better outcomes were found in group A than in group B, including QuickDASH scores (4.4 ± 5.9 vs. 12.9 ± 9.9) and grip strength (37.4 ± 5.1 vs. 29.1 ± 5.9 kg). Significantly better range of motion was found in group A than in group B with respect to supination (81.9° ± 4.3° vs. 75° ± 8.5°), extension (84.6 ± 4.3 vs. 76.7 ± 6.5), and flexion (80.4° ± 3.8° vs. 72° ± 4.1°). The difference was not significant in case of pronation (78.8° ± 3° vs. 74.3° ± 5.9°) and with respect to pain scores (0.6 ± 0.7 vs. 1.3 ± 1).
Both osseous and soft tissue lesions need to be fully addressed in ulnar styloid fractures. Early detection and surgical repair yielded better outcomes. Higher complication rates in late-treated fractures show that surgeons should select surgical candidates and modalities properly.
尺骨茎突骨折的手术固定作用仍存在争议。本研究的目的是比较早期和晚期干预后的手术效果。
我们回顾性分析了2004年至2014年间28例因单侧尺骨茎突骨折伴下尺桡关节不稳而接受手术修复的患者。13例患者（A组）在受伤后3个月内进行了手术固定，15例患者（B组）在受伤3个月后进行了手术固定。比较两组患者的特征和功能结果。结果调查包括QuickDASH评分、握力、活动范围、基于视觉模拟量表的疼痛评分和手术并发症。计算关键变量的描述性统计数据。p值<0.01被认为具有统计学意义。
两组患者的年龄、性别、受伤侧、优势侧损伤和合并桡骨远端骨折等特征无显著差异。A组手术平均时间为1.1个月，B组为12.3个月。A组的结果明显优于B组，包括QuickDASH评分（4.4±5.9 vs. 12.9±9.9）和握力（37.4±5.1 vs. 29.1±5.9 kg）。A组在旋后（81.9°±4.3° vs. 75°±8.5°）、伸展（84.6±4.3 vs. 76.7±6.5）和屈曲（80.4°±3.8° vs. 72°±4.1°）方面的活动范围明显优于B组。旋前（78.8°±3° vs. 74.3°±5.9°）和疼痛评分（0.6±0.7 vs. 1.3±1）方面差异不显著。
尺骨茎突骨折时，骨和软组织损伤均需得到充分处理。早期发现和手术修复可取得更好的效果。晚期治疗骨折的并发症发生率较高，表明外科医生应正确选择手术患者和手术方式。
