桡骨远端骨折后影像学参数变化与三角纤维软骨复合体损伤的相关性。
Association between imaging parameter changes and triangular fibrocartilage complex injury after distal radius fractures.
机构信息
First People's Hospital of Changzhou Affiliated to Soochow University, Changzhou, Jiangsu, People's Republic of China.
Department of Trauma Center and Orthopedic Surgery, The First People's Hospital of Changzhou Affiliated to Soochow University, Juqian Road 185, Changzhou, 213000, Jiangsu, People's Republic of China.
出版信息
J Orthop Surg Res. 2023 Dec 9;18(1):946. doi: 10.1186/s13018-023-04438-5.
BACKGROUND
Triangular fibrocartilage complex (TFCC) injury is a frequent soft tissue injury that has been observed to accompany distal radius fractures (DRFs) with concomitant changes in radiologic parameters. The aim of this study was to investigate the relevance of distal radial radiologic parameters associated with DRF and traumatic TFCC injury.
METHODS
A total of 172 patients with distal radius fractures who underwent X-ray, CT, and MRI before undergoing volar locking plate or external splint fixation between October 2021 and December 2022 were included in this study. An analysis of various radiologic parameters and the classification of fracture type and TFCC injuries by CT and MRI was performed. All patients were divided into the TFCC uninjured group and the injured group. The incidence and relevant radiologic parameters were compared.
RESULTS
This study included 76 males and 96 females with a mean age of 56.1 years. Among all patients, 33 (19.2%), 40 (23.2%), and 99 (57.6%) had DRF with A, B, and C fractures, respectively, according to the AO/OTA classification. In patients with fractures, the TFCC was found to be injured in 54.1% (93/172) of patients (type 1A in 21, 1B in 46, 1C in 39, and 1D in 35) but uninjured in 45.9% (79/172). There were significant differences between the TFCC injured and uninjured groups regarding the radius length (p = 0.044) and DRUJ distance (p = 0.040) of radiologic parameters that changed with DRF, although there were no differences between the two groups regarding gender, age, injured side, intra- and extra-articular, radius inclination and palmer tilt angle, or sagittal translation. Within the TFCC injured group, the radius length and DRUJ distance were 4.83 mm and 2.95 mm less or wider than 7.19 mm and 1.83 mm of the uninjured group. Moreover, shorter radius length was related to type lB TFCC injury (p = 0.041). Both radius length (AUC = 0.658) and DRUJ distance (AUC = 0.582) had no convincing predictive value for TFCC injury in DRF.
CONCLUSION
1B TFCC injury is most common in patients with DRF and concomitant TFCC injury. Both radius length and DRUJ distance have a significant statistical correlation with TFCC injury, and patients with TFCC injury tend to have a shortened radius and wider DRUJ distance, although they have no predictive value for TFCC injury in DRF. In addition, a shorter radius length was related to type lB TFCC injury.
背景
三角纤维软骨复合体（TFCC）损伤是一种常见的软组织损伤，在伴有桡骨远端骨折（DRF）时经常观察到，同时伴有影像学参数的变化。本研究旨在探讨与 DRF 相关的桡骨远端影像学参数与创伤性 TFCC 损伤的相关性。
方法
本研究纳入了 2021 年 10 月至 2022 年 12 月期间因 DRF 接受掌侧锁定钢板或外固定夹板固定治疗的 172 例患者，所有患者均接受 X 线、CT 和 MRI 检查。分析了各种影像学参数以及 CT 和 MRI 对骨折类型和 TFCC 损伤的分类。所有患者均分为 TFCC 未损伤组和损伤组。比较两组的发生率和相关影像学参数。
结果
本研究共纳入 76 例男性和 96 例女性患者，平均年龄为 56.1 岁。根据 AO/OTA 分类，所有患者中分别有 33 例（19.2%）、40 例（23.2%）和 99 例（57.6%）为 A、B 和 C 型 DRF。在骨折患者中，发现 TFCC 在 54.1%（93/172）的患者中受伤（1A 型 21 例，1B 型 46 例，1C 型 39 例，1D 型 35 例），而在 45.9%（79/172）的患者中未受伤。在桡骨长度（p=0.044）和 DRUJ 距离（p=0.040）这两个与 DRF 变化相关的影像学参数方面，TFCC 损伤组和未损伤组之间存在显著差异，但两组在性别、年龄、受伤侧、关节内和关节外、桡骨倾斜和掌倾角度或矢状面平移方面无差异。在 TFCC 损伤组中，桡骨长度和 DRUJ 距离分别比未损伤组的 7.19mm 和 1.83mm 少 4.83mm 和宽 2.95mm。此外，较短的桡骨长度与 1B 型 TFCC 损伤有关（p=0.041）。桡骨长度（AUC=0.658）和 DRUJ 距离（AUC=0.582）对 DRF 中 TFCC 损伤均无明显的预测价值。
结论
1B 型 TFCC 损伤在 DRF 合并 TFCC 损伤的患者中最为常见。桡骨长度和 DRUJ 距离与 TFCC 损伤均有显著的统计学相关性，TFCC 损伤患者的桡骨长度往往较短，DRUJ 距离较宽，但对 DRF 中的 TFCC 损伤无预测价值。此外，较短的桡骨长度与 1B 型 TFCC 损伤有关。
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