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桡骨远端冠状位骨性结构匹配的评估及临床意义

Evaluation and clinical significance of coronal bone structure matching in distal radius fractures

摘要:

目的:评估正常人群及桡骨远端骨折患者桡骨远端冠状位骨性结构匹配值及临床意义。方法:选取80例正常成人的腕关节薄层CT,利用Mimics 20.0和3-Matic research软件测量桡骨远端冠状位骨性结构匹配数据。收集2016年1月至2018年12月采用切开复位掌侧钢板内固定治疗的44例桡骨远端骨折患者,按冠状位匹配是否在正常范围内分为匹配组及不匹配组。术后3个月及12个月根据X线片评估两组患者骨折愈合情况、桡骨高度、尺偏角及掌倾角恢复情况,采用视觉模拟评分(visual analogue scale,VAS)和上肢功能障碍(disability of arm, shoulder and hand, DASH)评分对患者腕痛和腕关节功能进行评价,比较两组患者的握力及腕关节活动度。结果:80例正常成年人桡骨远端冠状位骨性结构匹配值为45.0%±16.2%。44例桡骨远端骨折患者均获平均16个月随访,术后创面均愈合良好,术后3个月均达到骨性愈合标准。术后3个月,不匹配组桡骨高度、尺偏角、掌倾角均较匹配组小,但差异均无统计学意义;旋前角度,不匹配组(68.82°±11.62°)较匹配组(76.91°±9.14°)小,差异有统计学意义( t=2.567, P=0.014);DASH评分,不匹配组(15.53±2.36)分较匹配组[(13.62±2.52)分]大,差异有统计学意义( t=2.591, P=0.013)。术后12个月,VAS评分匹配组为(2.08±2.95)分小于不匹配组(2.95±1.24)分,差异有统计学意义( t=2.348, P=0.024);两组腕关节活动度、握力、DASH评分比较,差异均无统计学意义。 结论:正常人群桡骨远端冠状位骨性结构匹配约为45.0%。当桡骨远端骨折术后匹配程度不在正常值范围内时,腕关节可出现早期功能障碍、旋前活动受限及腕关节疼痛。

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abstracts:

Objective:To study the coronal bone structure matching of distal radius in normal population and some patients with postoperative distal radius fracture, and to explore the clinical significance of coronal bone structure reduction of distal radius fracture.Methods:CT scans of 80 asymptomatic wrists were performed. Mimics 20.0 and 3-Matic research software were used to measure the matching data of coronal bone structure of the distal radius. Total of 44 patients with distal radius fractures treated with open reduction and volar plate fixation were collected. According to the data coronal bone structure of the distal radius, the matching group was in the normal range, and the mismatching group was less than the normal range. X-ray films were used to evaluate fracture healing, humeral height, ulnar angle and palm tilt angle at 3 months and 12 months after operation. The clinical indexes of wrist pain, wrist function, grip strength and activity were recorded in 2 groups. The DASH score was used for evaluation, and statistical comparisons was made between the two groups of related indicators.Results:The coronal bone structure matching value of the distal radius in 80 normal adults was 45.0%±16.2%. All the 44 patients with distal radius fracture were followed up for an average of 16 months. The postoperative wound healing was good, and the bone healing standard was reached 3 months after the operation. 3 months after surgery, radius height, ulnar deviation angle and palmar inclination angle of the mismatched group were all smaller than those of the matched group, but the differences had no statistical significance. The pronation angle in the mismatched group (68.82°±11.62°) was lower than that in the matched group (76.91°±9.14°), and the difference was statistically significant ( t=2.567, P=0.014). The DASH score in the mismatched group (15.53±2.36) was higher than that in the matched group (13.62±2.52), and the difference was statistically significant ( t=2.591, P=0.013). 12 months after surgery, the VAS score of the matched group (2.08±2.95) was less than that of the mismatched group (2.95±1.24), and the difference was statistically significant ( t=2.348, P=0.024). There was no significant difference in wrist range of motion, grip strength and DASH score between the two groups. Conclusion:The coronal bone structure matching of distal radius is about 45.0% in normal population. Early wrist dysfunction, limited pronation, and wrist pain may occur when the postoperative matching degree of the distal radius fracture is not within the normal range.

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作者: 张鑫 季佳庆 姚英 李山珠 周家钤 殷勇 袁锋 樊健
期刊: 《中华骨科杂志》2021年41卷6期 368-375页 ISTICPKUCSCDCA
栏目名称: 临床论著
DOI: 10.3760/cma.j.cn121113-20190929-00409
发布时间: 2021-04-06
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