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鉤鋼板治療鎖骨外側端骨折伴肩鎖關節脫位

低位進釘法動力髖螺釘治療高齡股骨粗隆間骨折

【摘 要】 目的 總結利用低位進釘法動力髖螺釘（dynamic hip screw，DHS）治療高齡股骨粗隆間骨折的臨床經驗。 方法 2000 年1 月－ 2006 年12 月，利用低位進釘法DHS 治療高齡骨質疏松股骨粗隆間骨折25 例。男11 例，女14 例；年齡70 ～ 92 歲，平均81 歲。致傷原因：撞摔傷6 例，跌倒傷19 例。病程1 ～ 7 d。骨折類型按Evan’s 分型，Ⅰ型3 例，Ⅱ型10 例，Ⅲ型8 例，Ⅳ型4 例。伴其他部位骨折4 例，顱腦損傷1 例。合并高血壓病12 例，冠心病3 例，糖尿病1 例，腦血管病1 例，慢性支氣管炎和肺氣腫1 例。 結果 術中出現低血壓4 例，靜脈輸血和應用升壓藥物后好轉。術后1 個月內發生并發癥13 例，其中肺部感染4 例，精神障礙3 例，深靜脈血栓、腸道感染、心律失常、心肌梗死各1 例，經抗感染、抗精神藥物、溶栓等內科治療后無死亡患者。全部患者均獲隨訪，隨訪時間6 個月～ 3 年，平均21 個月。骨折平均愈合時間為14 周。參照Harris 評分標準，優9 例，良12 例，可3 例，差1 例，優良率84%。無螺釘松動、移位、滑出等內固定失敗發生。 結論 低位進釘法DHS 是治療高齡股骨粗隆間骨折較好的方法，選擇恰當的手術時機、采用正確的手術方法、術后適當的功能鍛煉是取得滿意療效的關 鍵。

Comparative study of short-term effectiveness of three surgical methods for ulnar styloid base fracture complicated with triangular fibrocartilage complex injury

Objective To compare the short-term effectiveness of arthroscopic suture of triangular fibrocartilage complex (TFCC), arthroscopic suture of TFCC combined with open reduction and internal fixation, and simple open reduction and internal fixation in the treatment of distal radius fractures combined with ulnar styloid base fractures and TFCC injury. Methods A clinical data of 97 patients with distal radius fractures combined with ulnar styloid base fracture and TFCC injury, who were admitted between September 2019 and September 2022 and met the selective criteria, was retrospectively analyzed. After reduction and internal fixation of distal radius fractures, 37 cases underwent arthroscopic suture of TFCC (TFCC group), 31 cases underwent arthroscopic suture of TFCC combined with open reduction and internal fixation of ulnar styloid base fractures (combination group), and 29 cases underwent simple open reduction and internal fixation of ulnar styloid base fractures (internal fixation group). There was no significant difference in baseline data between groups (P>0.05), such as gender, age, injury side, time from injury to operation, and preoperative radius height, palm inclination, ulnar deviation, grip strength, wrist range of motion (ROM) in rotation, ulnar-radial deviation, and flexion-extension. The differences (change value) in radius height, metacarpal inclination angle, ulnar deviation angle, grip strength, and wrist ROM in rotation, ulnar-radial deviation, and flexion-extension between preoperative and 12 months after operation in 3 groups were compared. The effectiveness was evaluated according to the modified Gartland-Werley score at 12 months after operation. Results All incisions healed by first intention. All patients were followed up 12-18 months (mean, 14 months). X-ray films showed that there were 4 patients with non-union of ulnar styloid base fracture in TFCC group, and the remaining patients had fracture healing at 3 months after operation. The radius height, palm inclination, and ulnar deviation of 3 groups at 12 months after operation were significantly better than those before operation (P<0.05); however, the differences in the change values of the above indexes between groups was not significant (P>0.05). At 12 months after operation, the change values of wrist ROM in rotation, ulnar-radial deviation, and flexion-extension in the TFCC group and the combination group were significantly greater than those in the internal fixation group (P<0.05), and there was no significant difference between the TFCC group and the combination group (P>0.05). The change values of grip strength was significantly greater in the combination group than in the internal fixation group (P<0.05); there was no significant difference between the other groups (P>0.05). The excellent and good rates according to the modified Gartland-Werley score were 91.89% (34/37), 93.54% (29/31), and 72.41% (21/29) in the TFCC group, the combination group, and the internal fixation group, respectively. The excellent and good rates of the TFCC group and the combination group were significantly higher than that of the internal fixation group (P<0.05); there was no significant difference between the TFCC group and the combination group (P>0.05).ConclusionFor ulnar styloid base fractures with TFCC injury, compared with simple open reduction and internal fixation, arthroscopic suture of TFCC or suture TFCC combined with internal fixation treatment are both beneficial for wrist function recovery, and their short-term effectiveness are similar. Therefore, arthroscopic suture of TFCC may be a better choice.