桡骨远端骨折伴尺骨茎突骨折：桡尺远侧关节的稳定性是否取决于尺骨茎突骨折的位置？
Distal radius fracture with concomitant ulnar styloid fracture: does distal radioulnar joint stability depend on the location of the ulnar styloid fracture?
机构信息
Department of Orthopaedic Surgery, Dankook University Hospital, Cheonan, South Korea.
Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Seongnam, South Korea.
出版信息
Arch Orthop Trauma Surg. 2023 Feb;143(2):839-845. doi: 10.1007/s00402-021-04199-y. Epub 2021 Oct 7.
INTRODUCTION
Studies are conflicting regarding the relationship between ulnar styloid fracture (USF) location and distal radioulnar joint (DRUJ) instability in patients with distal radius fracture (DRF) and concomitant USF. The objective of this study was to determine the association of USF location with TFCC foveal tear and factors associated with DRUJ instability in patients with both DRF and USF.
MATERIALS AND METHODS
Fifty-four patients with both DRF and USF who had wrist MRI examination before surgery were analyzed. USF location (tip or base) and TFCC foveal insertion status (intact, partial tear, or complete tear or avulsion with fractured fragment) were evaluated. DRUJ stability was assessed intra-operatively after fixation of the radius. Factors potentially associated with DRUJ instability, such as age, gender, USF location, USF fragment gap, radioulnar distance, radial shortening, and TFCC foveal tear, were analyzed.
RESULTS
Among 54 patients, 37 (69%) and 17 (31%) had USF at the base and the tip, respectively. In patients with base fractures, TFCC foveal insertion was found to be disrupted in 89% (33/37) patients (complete tear in 11 and partial tear in 22) but intact in 11% (4/37). On the contrary, in patients with tip fractures, the insertion was found to be disrupted in 88% (15/17) patients (complete tear in 2 and partial tear in 13) but intact in 12% (2/17). After fixation of the radius, total 52% (28/54) patients showed DRUJ instability. Especially, DRUJ instability was found in 57% (21/37) of ulna styloid process base fracture patients and 41% (7/17) of ulna styloid process tip fracture patients. In univariate analysis, complete tear of TFCC foveal insertion and wider USF fragment distance were associated with DRUJ instability.
CONCLUSIONS
Tears of TFCC foveal insertion are common in patients with DRF and concomitant ulnar styloid base fractures. Based on the findings of this study, tear of TFCC foveal insertion seems to be also common in patients with DRF and concomitant ulnar styloid tip fractures. And also, DRUJ instability seems to be associated with a TFCC foveal tear independent of USF location.
简介
在伴有尺骨茎突骨折（USF）的桡骨远端骨折（DRF）患者中，关于 USF 位置与下尺桡关节（DRUJ）不稳定之间的关系，研究结果存在矛盾。本研究的目的是确定 USF 位置与 TFCC 窝状插入撕裂的关系，并确定与伴有 DRF 和 USF 的患者的 DRUJ 不稳定相关的因素。
材料和方法
分析了 54 例术前接受腕关节 MRI 检查的同时患有 DRF 和 USF 的患者。评估了 USF 位置（尖端或基底）和 TFCC 窝状插入状态（完整、部分撕裂或完全撕裂或伴有骨折碎片的撕脱）。在固定桡骨后，术中评估 DRUJ 的稳定性。分析了可能与 DRUJ 不稳定相关的因素，如年龄、性别、USF 位置、USF 碎片间隙、尺桡骨间距、桡骨缩短和 TFCC 窝状撕裂。
结果
在 54 例患者中，37 例（69%）和 17 例（31%）USF 位于基底和尖端。在基底骨折患者中，TFCC 窝状插入被发现有 89%（33/37）的患者（完全撕裂 11 例，部分撕裂 22 例）中断，但有 11%（4/37）的患者插入完整。相反，在尖端骨折患者中，有 88%（15/17）的患者插入被发现中断（完全撕裂 2 例，部分撕裂 13 例），但有 12%（2/17）的患者插入完整。固定桡骨后，52%（28/54）的患者出现 DRUJ 不稳定。特别是，尺骨茎突基底骨折患者中 DRUJ 不稳定的发生率为 57%（21/37），尺骨茎突尖端骨折患者中 DRUJ 不稳定的发生率为 41%（7/17）。在单因素分析中，TFCC 窝状插入的完全撕裂和更大的 USF 碎片距离与 DRUJ 不稳定相关。
结论
在伴有桡骨远端骨折和尺骨茎突基底骨折的患者中，TFCC 窝状插入撕裂较为常见。根据本研究的结果，TFCC 窝状插入撕裂在伴有桡骨远端骨折和尺骨茎突尖端骨折的患者中似乎也很常见。并且，DRUJ 不稳定似乎与 TFCC 窝状撕裂有关，而与 USF 位置无关。
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