摘要目的:探讨在桡骨远端骨折中出现Lister结节尺侧游离皮质骨片的特点及临床意义。方法:我科自2021年1月至2023年10月治疗伴有Lister结节尺侧游离皮质骨片且明显移位的患者5例，均采用掌侧入路桡骨远端解剖锁定板内固定手术，1例术中未加用背侧切口，其余4例加用背侧切口处理游离骨片。按1∶4配对选取20例不伴有背侧Lister结节游离皮质骨片的桡骨远端骨折患者，测量骨折的移位特征，如掌倾角、尺偏角及桡骨高度改变。另选取20例正常人腕关节CT资料，经影像重建后测量腕背第三伸肌鞘管的骨皮质解剖数据。结果:5例患者中，未加用背侧切口的1例术后发生拇长伸肌腱断裂，二次手术修复拇长伸肌腱并切除游离骨片；4例加用背侧切口对游离骨片进行处理，发现拇长伸肌腱均有不同程度的挫伤。术后随访1年，5例患者Gartland-Werley腕关节功能评分平均1.6分为优，上肢功能DASH评分平均13分。该5例患者的骨折移位特征与普通桡骨远端骨折并无差异。CT测量的正常第三伸肌鞘管底的形态数据与游离皮质骨片大小相当。结论:在桡骨远端骨折中存在Lister结节尺侧游离皮质骨片并向远侧移位时，第三伸肌鞘管受到影响，将干扰拇长伸肌腱的滑行轨迹，建议加用背侧切口予以处理(去除或剪碎用于植骨)。

abstractsObjective:To explore the characteristics and clinical significance of free cortical fragment on the ulnar side of Lister′s tubercle in distal radius fractures.Methods:From January 2021 to October 2023, 5 patients with free cortical fragment on the ulnar side of Lister′s tubercle in distal radius fractures were treated. All patients underwent anatomical locking plate internal fixation of the distal radius through palmar approach. One patient did not use a dorsal incision during the operation, while the remaining 4 patients used a dorsal incision to treat free bone fragments. Twenty patients with distal radius fractures without dorsal Lister′s tubercle free cortical fragment were selected in a 1∶4 pairing, and the displacement characteristics of the fractures were measured, such as palmar inclination angle, ulnar deviation angle, and changes in radius height. Another 20 normal wrist joint CT data were selected, and after image reconstruction, the cortical anatomical data of the third extensor sheath in the dorsal wrist were measured.Results:Among the 5 patients, one without the addition of a dorsal incision developed a rupture of the extensor hallucis longus tendon after surgery. A second surgery was performed to repair the extensor hallucis longus tendon and the free bone fragment was removed. Four additional dorsal incisions were used to treat free bone fragments, and it was found that the extensor hallucis longus tendon had varying degrees of contusion. After 1 year of postoperative follow-up, the average score of Gartland-Werley wrist joint function in 5 patients was 1.6, which was excellent, and the average DASH score of upper limb function was 13. The fracture displacement characteristics of these 5 patients were not different from those of ordinary distal radius fractures. The morphological data of the normal third extensor sheath tube bottom measured by CT was equivalent in size to the free cortical bone fragment.Conclusion:In distal radius fractures, the presence of free cortical fragment on the ulnar side of Lister′s tubercle with distal displacement can affect the third extensor sheath and interfere with the sliding trajectory of the extensor hallucis longus tendon. It is recommended to use a dorsal incision for treatment (removal or cutting for bone grafting).