切换至 "中华医学电子期刊资源库"
高级检索
中华肩肘外科电子杂志

中华肩肘外科电子杂志 ›› 2023, Vol. 11 ›› Issue (04) : 344 -349. doi: 10.3877/cma.j.issn.2095-5790.2023.04.008

论著

钩钢板治疗不稳定尺骨远端骨折合并桡骨远端骨折的疗效
冷昆鹏, 孟钰童, 刘洋, 尹博, 周君琳†()   
  1. 100020　首都医科大学附属北京朝阳医院骨科
  • 收稿日期:2023-08-27 出版日期:2023-11-05
  • 通信作者: 周君琳
  • 基金资助:
    国家自然科学基金资助项目(82002280); 国家自然科学基金资助项目(82272469); 北京市自然科学基金资助项目(7234371); 北京市临床重点专科项目经费资助(BJYQFZ-2022)

Efficacy of hook-plate osteosynthesis in the treatment of unstable distal ulnar fracture combined with distal radial fracture

Kunpeng Leng, Yutong Meng, Yang Liu, Bo Yin, Junlin Zhou†()   

  1. Department of Orthopedics, Beijing Chao-Yang Hospital, Capital Medical University, Beijing 100020, China
  • Received:2023-08-27 Published:2023-11-05
  • Corresponding author: Junlin Zhou
全文 ( ) 下载PDF ( ) 导出引用
引用本文：

冷昆鹏, 孟钰童, 刘洋, 尹博, 周君琳. 钩钢板治疗不稳定尺骨远端骨折合并桡骨远端骨折的疗效[J]. 中华肩肘外科电子杂志, 2023, 11(04): 344-349.

Kunpeng Leng, Yutong Meng, Yang Liu, Bo Yin, Junlin Zhou. Efficacy of hook-plate osteosynthesis in the treatment of unstable distal ulnar fracture combined with distal radial fracture[J]. Chinese Journal of Shoulder and Elbow(Electronic Edition), 2023, 11(04): 344-349.

目的

回顾性分析应用钩钢板治疗不稳定尺骨远端骨折合并桡骨远端骨折的临床疗效。

方法

选取2018年1月至2022年5月本院收治的31例不稳定尺骨远端骨折合并桡骨远端骨折患者作为研究对象，临床疗效评估包括患者腕关节活动范围、握力、快速臂肩手障碍评分（quick disabilities of the arm,shoulder and hand，Q-DASH）和Mayo腕关节评分，通过术后X线评估桡骨高度、尺骨变异、掌倾角、尺偏角和骨折愈合情况。

结果

共31例患者，平均年龄为（66±9）岁，平均随访时间为（15±3）个月。最终随访时，腕关节活动度平均掌屈为（49±7）°、背伸（45±6）°、旋前（81±4）°、旋后（79±5）°，握力为（19±6）kg。临床评分为良好至优秀，平均Q-DASH评分为（14±9）分，Mayo腕关节评分为（87±7）分。

结论

钩钢板是不稳定尺骨远端骨折合并桡骨远端骨折患者手术治疗的理想选择，通过早期康复锻炼可以获得满意的腕关节功能恢复。

关键词: 不稳定尺骨远端骨折, 钩钢板, 桡骨远端骨折
Background

Distal ulnar and distal radial fractures are rare injuries, accounting for approximately 5.6% of all distal radial fractures. There is some controversy regarding the treatment methods for distal ulnar fractures. Some literature suggests that the clinical outcomes of distal ulnar fractures treated conservatively are poor. Unstable distal ulnar fractures may affect the function of the distal radioulnar joint and forearm rotation stability, leading to nonunion, chronic wrist pain, and instability. Consequently, some scholars recommend surgical treatment for unstable or displaced distal ulnar fractures after fixation of the distal radial fractures. For small distal ulnar fracture fragments, particularly in elderly patients with osteoporotic fractures, the effectiveness of internal fixation methods such as Kirschner wires or locking plates is limited. In comparison, the ulna distal locking hook plate presents advantages in anatomical design and smooth edges, reducing irritation to soft tissues and decreasing the risk of reduction loss, thus achieving a more robust fracture fixation.

Objective

To retrospectively analyze the clinical effect of hook-plate osteosynthesis in the treatment of unstable distal ulnar fracture combined with distal radial fracture.

Methods

Thirty-one cases of unstable distal ulnar fractures combined with distal radial fractures were admitted to our hospital from January 2018 to May 2022 and selected as the subjects for the study. Clinical efficacy assessment included wrist joint range of motion, grip strength, Q-DASH score, and Mayo wrist joint score. Postoperative X-ray evaluations were conducted to assess radial height, ulnar variance, volar tilt, ulnar tilt, and fracture healing status.

Results

Thirty-one patients were included in this study, with an average age of (66±9) years and a mean follow-up duration of (15±3) months. At the final follow-up, the average wrist joint range of motion was as follows: (49±7) ° of palmar flexion, (45±6) ° of dorsiflexion, (81±4) ° of pronation, and (79±5) ° of supination. Grip strength measured (19±6) kilograms. Clinical assessments ranged from good to excellent, with an average Q-DASH score of (14±9) and a Mayo wrist joint score of (87±7) .

Conclusion

The hook plate is an ideal choice for surgical treatment in patients with unstable distal ulnar fractures combined with distal radial fractures. Satisfactory recovery of wrist joint function can be achieved through early rehabilitation exercises.

Key words: Unstable distal ulnar fracture, Hook plate, Distal radial fracture
图1 钩钢板治疗不稳定尺骨远端骨折合并桡骨远端骨折，62岁女性，自行摔伤致左尺桡骨远端骨折　图A：术前腕关节正侧位X线片；图B：术后1 d腕关节正侧位X线片；图C：术后1年腕关节正侧位X线片；图D：术后1年复查患者腕关节功能位（掌屈位、背伸位、旋后位、旋前位）
表1 31例患者的一般情况
指标 数值
性别（女/男）[例（%）] 25（81）/6（19）
年龄（岁，±s） 66±9
体重（kg，±s） 65±10
身高（cm，±s） 163±9
BMI（±s） 24.8±4.6
受伤机制[例（%）]  
低能量损伤 23（74）
高能量损伤 8（26）
尺骨远端骨折Biyani分型[例（%）]  
I型 7（23）
II型 4（13）
III型 5（16）
IV型 15（48）
表2 31例患者最终随访时临床效果评估及影像学评估（±s）
指标 数值
随访时间（月） 15±3
临床评分（分）  
Q-DASH评分 14±9
Mayo腕关节评分 87±7
活动度（°）  
掌屈 49±7
背伸 45±6
旋前 81±4
旋后 79±5
握力（kg） 19±6
影像学评估  
掌倾角（°） 3.3±4.7
尺偏角（°） 19.6±3.7
桡骨高度（mm） 10.1±1.1
尺骨变异（mm） -1.3±1.1
表3 尺骨远端钩钢板治疗年轻组和老年组受伤机制及骨折分型比较
组别 受伤机制（能量） 尺骨远端骨折Biyani分型
低 高 I II III IV
年轻组（<65岁） 8 6 4 2 2 6
老年组（≥65岁） 15 2 3 2 3 9
x2值 3.876 0.658
P值 0.042 0.883
表4 年轻组和老年组尺骨远端钩钢板治疗效果比较（±s）
组别 临床评分（分） 活动度（°） 握力（kg） 影像学评估
Q-DASH评分 Mayo腕关节评分 掌屈 背伸 旋前 旋后 掌倾角（°） 尺偏角（°） 桡骨高度（mm） 尺骨变异（mm）
年轻组（<65岁） 7±6 90±6 55±4 50±5 82±3 79±4 25±3 3.4±4.4 20.6±4.3 10.6±1.1 -1.3±0.7
老年组（≥65岁） 19±8 85±6 44±4 43±5 81±4 78±5 14±3 3.3±5.0 18.8±3.0 9.7±1.0 -1.2±1.3
t值 5.206 4.735 7.472 4.343 0.627 0.822 6.324 0.062 1.292 0.798 0.078
P值 0.030 0.041 0.013 0.011 0.536 0.418 0.026 0.951 0.210 0.489 0.905
[1]
Biyani A, Simison AJ, Klenerman L. Fractures of the distal radius and ulna[J]. J Hand Surg Br, 1995, 20（3）: 357-364.
[2]
Foster BJ, Bindra RR. Intrafocal pin plate fixation of distal ulna fractures associated with distal radius fractures[J]. J Hand Surg Am, 2012, 37（2）: 356-359.
[3]
Mckee MD, Waddell JP, Yoo D, et al. Nonunion of distal radial fractures associated with distal ulnar shaft fractures: a report of four cases[J]. J Orthop Trauma, 1997, 11（1）: 49-53.
[4]
Ruchelsman DE, Raskin KB, Rettig ME. Outcome following acute primary distal ulna resection for comminuted distal ulna fractures at the time of operative fixation of unstable fractures of the distal radius[J]. Hand （N Y）, 2009, 4（4）: 391-396.
[5]
Seitz WH Jr, Raikin SM. Resection of comminuted ulna head fragments with soft tissue reconstruction when associated with distal radius fractures[J]. Tech Hand Up Extrem Surg, 2007, 11（4）: 224-230.
[6]
张鹏, 王天兵. 下尺桡关节损伤的研究进展[J/CD]. 中华肩肘外科电子杂志, 2014,2（3）: 200-203.
[7]
Dennison DG. Open reduction and internal locked fixation of unstable distal ulna fractures with concomitant distal radius fracture[J]. J Hand Surg Am, 2007, 32（6）: 801-805.
[8]
Fernandez DL, Ring D, Jupiter JB. Surgical management of delayed union and nonunion of distal radius fractures[J]. J Hand Surg Am, 2001, 26（2）: 201-209.
[9]
Ring D, Mccarty LP, Campbell D, et al. Condylar blade plate fixation of unstable fractures of the distal ulna associated with fracture of the distal radius[J]. J Hand Surg Am, 2004, 29（1）: 103-109.
[10]
Lee BG, Lee SH. Feasibility study of juxta-articular-type volar distal radius plate （ARIX Wrist System） for surgically treating marginal distal radius fractures[J]. Heliyon, 2023, 9（4）: e14934.
[11]
Muellner T, Fuchs M, Kwasny O. Rotational instability and integrity of the interosseous membrane in cadaveric ulnar shaft fractures[J]. Arch Orthop Trauma Surg, 1998, 118（1-2）: 53-56.
[12]
Tarr RR, Garfinkel AI, Sarmiento A. The effects of angular and rotational deformities of both bones of the forearm. An in vitro study[J]. J Bone Joint Surg Am, 1984, 66（1）: 65-70.
[13]
Yasutomi T, Nakatsuchi Y, Koike H, et al. Mechanism of limitation of pronation/supination of the forearm in geometric models of deformities of the forearm bones[J]. Clin Biomech （Bristol, Avon）, 2002, 17（6）: 456-463.
[14]
Liang B, Lai JM, Murugan A, et al. Proposed Guidelines for Treatment of Concomitant Distal Radius and Distal Ulna Fractures[J]. Hand Surg, 2015, 20（3）: 396-401.
[15]
Cha SM, Shin HD, Kim KC, et al. Treatment of unstable distal ulna fractures associated with distal radius fractures in patients 65 years and older[J]. J Hand Surg Am, 2012, 37（12）: 2481-2487.
[16]
Pansard E, Chantelot C, Mares O. Fracture of the distal radius associated with an articular comminutive fracture of the distal ulna: treatment in emergency by osteosynthesis of the radius by volar locking plate for the radius and a resection of the distal end of the ulna: report of one case[J]. Chir Main, 2011, 30（1）: 69-72.
[17]
Klopfer T, Hemmann P, Rupprecht V, et al. Outcome Analysis of Distal Radius Fracture with Orthosis Versus Cast Immobilization after Palmar Plate Osteosynthesis: A Randomized Controlled Study[J]. J Pers Med, 2023, 13（1）:130.
[18]
Boretto JG, Zaidenberg EE, Gallucci GL, et al. Comparative Study of Internal Fixation of the Ulna and Distal Ulna Resection in Patients Older Than 70 Years With Distal Radius and Distal Metaphyseal Ulna Fractures[J]. Hand （N Y）, 2019, 14（4）: 540-546.
[19]
Amundsen A, Rizzo M, Berger R, et al. Outcomes following Distal Radioulnar Joint Arthroplasty in the Setting of Total or Partial Wrist Fusion[J]. J Wrist Surg, 2022, 11（6）: 501-508.
[20]
Richards TA, Deal DN. Distal ulna fractures[J]. J Hand Surg Am, 2014, 39（2）: 385-391.
[21]
Satria O, Wikanjaya R, Tenges CA, et al. Minimally Invasive Plating of Distal Radius Fracture: A Series of 42 Cases and Review of Current Literature[J]. Minim Invasive Surg, 2023, 2023: 3534849.
[22]
张殿英. 基于杠杆重建理论对长骨干骨折内固定治疗的新认识[J]. 中华骨科杂志, 2022, 42（5）: 265-271.
[23]
Gschwentner M, Arora R, Wambacher M, et al. Distal forearm fracture in the adult: is ORIF of the radius and closed reduction of the ulna a treatment option in distal forearm fracture?[J]. Arch Orthop Trauma Surg, 2008, 128（8）: 847-855.
[24]
Gauthier M, Beaulieu JY, Nichols L, et al. Ulna hook plate osteosynthesis for ulna head fracture associated with distal radius fracture[J]. J Orthop Traumatol, 2022, 23（1）: 39.
[25]
Berger RA, Cooney WP 3rd. Use of an ulnar head endoprosthesis for treatment of an unstable distal ulnar resection: review of mechanics, indications, and surgical technique[J]. Hand Clin, 2005, 21（4）: 603-620, vii.
[26]
Schmitt S, Eisa A, Radosavljevic J, et al. Dynamic palmar dislocation of the ulnar head at the distal radioulnar joint （DRUJ） after radius shaft malunion[J]. Arch Orthop Trauma Surg, 2023, 143（5）: 2781-2787.
[27]
Roberts T, Kocialcowski C, Cowey A. Dorsal bridging plates for the treatment of high and low energy distal radius fractures[J]. J Clin Orthop Trauma, 2022, 35: 102048.
[28]
张一翀, 王艳华, 张立佳, 等. 杠杆重建平衡理论分析锁骨骨折术后内固定失效的原因[J/CD]. 中华肩肘外科电子杂志, 2021, 9（4）: 310-317.
[29]
Tsai YJ, Yeh JP, Lin TH, et al. Hooked embracing plate for Rolando fracture fixation: a preliminary result[J]. BMC Surg, 2022, 22（1）: 419.
[30]
张殿英, 张晓萌, 郁凯, 等. 重视骨折固定与骨内、外在因素的关系[J/CD]. 中华肩肘外科电子杂志, 2018, 6（2）: 81-84.
[31]
Ratajczak P, Meller P, Kopciuch D, et al. Assessment of Patients' Quality of Life during Conservative Treatment after Distal Radius Fracture[J]. Int J Environ Res Public Health, 2022, 19（22）:14758.
[32]
Sato K, Murakami K, Mimata Y, et al. Conservative treatment of distal ulna metaphyseal fractures associated with distal radius fractures in elderly people[J]. Orthop Traumatol Surg Res, 2018, 104（7）: 1101-1105.
[1] 刘有才, 张义君, 赵欣磊, 周家玄. Endobutton带袢钛板与钩钢板治疗肩锁关节脱位病例的疗效比较[J]. 中华肩肘外科电子杂志, 2023, 11(03): 212-217.
[2] 王雄, 杨璐, 子树明, 魏文强, 梁志民, 顾峥嵘, 曹烈虎. TightRope钢板与锁骨钩钢板治疗Rockwood III型急性肩锁关节脱位的疗效比较分析[J]. 中华肩肘外科电子杂志, 2022, 10(04): 300-306.
[3] 何国文, 高大伟, 陈亮, 胡栢均. 保守治疗与锁骨钩钢板内固定手术治疗Rockwood Ⅲ型肩锁关节脱位的中长期疗效对比研究[J]. 中华肩肘外科电子杂志, 2022, 10(02): 110-114.
[4] 何国文, 高大伟, 陈亮, 胡栢均, 吴宇峰. Endobutton带袢钢板内固定与锁骨钩钢板内固定治疗RockwoodⅢ型肩锁关节脱位的中长期疗效观察[J]. 中华肩肘外科电子杂志, 2022, 10(02): 105-109.
[5] 贾建波, 易诚青, 何家文, 敖荣广, 张旭. 锁骨钩钢板内固定术后钢板钩与肩峰匹配性影像学研究[J]. 中华肩肘外科电子杂志, 2022, 10(01): 49-54.
[6] 钟浩博, 刘伟乐, 刘正蕊, 郑少伟, 黄守镔, 孙江森, 孙春汉, 李胜发. 三重带袢钢板技术治疗新鲜Rockwood Ⅲ型肩锁关节脱位手术创伤与临床疗效相关性研究[J]. 中华肩肘外科电子杂志, 2020, 08(04): 327-334.
[7] 柴雷子, 宋财, 刘杰, 田浩然, 张伟. 外固定支架结合克氏针治疗老年桡骨远端开放性骨折的疗效分析[J]. 中华肩肘外科电子杂志, 2020, 08(03): 243-247.
[8] 刘俊, 危蕾, 吴波, 廖苏平, 邢丹谋. 两种不同锁骨钩置钩法在Rock-Wood Ⅲ、Ⅳ、Ⅴ型肩锁关节脱位治疗中的比较分析[J]. 中华肩肘外科电子杂志, 2020, 08(03): 209-214.
[9] 任云峰, 赵烽, 熊鹰, 吴桐, 王杰, 肖甲宇, 杨慧勤. 桥接组合式内固定系统与锁骨钩钢板治疗Rockwood Ⅲ~ Ⅳ型肩锁关节脱位临床研究[J]. 中华肩肘外科电子杂志, 2020, 08(02): 113-117.
[10] 何洁铭, 王嘉. 急性肩锁关节脱位Rockwood Ⅲ~Ⅴ型手术治疗中锁骨钩钢板和袢钢板应用效果的比较分析[J]. 中华肩肘外科电子杂志, 2020, 08(01): 11-15.
[11] 吕鹏飞, 裴征, 张清华, 刘家帮. 老年桡骨远端关节内骨折保守与掌侧锁定钢板手术治疗的疗效比较[J]. 中华临床医师杂志(电子版), 2022, 16(06): 487-492.
[12] 佟训哲, 赵小林. 老年桡骨远端骨折的治疗方法研究[J]. 中华临床医师杂志(电子版), 2019, 13(03): 184-186.
[13] 刘俊, 吴俊义, 张杰. 手法复位联合小夹板外固定治疗桡骨远端骨折疗效观察[J]. 中华卫生应急电子杂志, 2017, 03(03): 163-165.
[14] 刘志元, 朱建国, 杨雷. 锁骨钩钢板内固定与Endobutton带袢钢板喙锁韧带重建治疗急性不稳定肩锁关节脱位的疗效对比[J]. 中华卫生应急电子杂志, 2016, 02(01): 21-25.
[15] 陈义藩, 郑宁. 肥胖对桡骨远端骨折锁定钢板治疗效果的影响[J]. 中华肥胖与代谢病电子杂志, 2019, 05(04): 201-204.
阅读次数
全文


摘要

版权所有 中华医学会 中华医学电子音像出版社有限责任公司  京ICP备14006079号-1  网络出版服务许可证：(署)网出证(京)字第075号