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钩钢板治疗锁骨外侧端骨折伴肩锁关节脱位

低位进钉法动力髋螺钉治疗高龄股骨粗隆间骨折

【摘 要】 目的 总结利用低位进钉法动力髋螺钉（dynamic hip screw，DHS）治疗高龄股骨粗隆间骨折的临床经验。 方法 2000 年1 月－ 2006 年12 月，利用低位进钉法DHS 治疗高龄骨质疏松股骨粗隆间骨折25 例。男11 例，女14 例；年龄70 ～ 92 岁，平均81 岁。致伤原因：撞摔伤6 例，跌倒伤19 例。病程1 ～ 7 d。骨折类型按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，颅脑损伤1 例。合并高血压病12 例，冠心病3 例，糖尿病1 例，脑血管病1 例，慢性支气管炎和肺气肿1 例。 结果 术中出现低血压4 例，静脉输血和应用升压药物后好转。术后1 个月内发生并发症13 例，其中肺部感染4 例，精神障碍3 例，深静脉血栓、肠道感染、心律失常、心肌梗死各1 例，经抗感染、抗精神药物、溶栓等内科治疗后无死亡患者。全部患者均获随访，随访时间6 个月～ 3 年，平均21 个月。骨折平均愈合时间为14 周。参照Harris 评分标准，优9 例，良12 例，可3 例，差1 例，优良率84%。无螺钉松动、移位、滑出等内固定失败发生。 结论 低位进钉法DHS 是治疗高龄股骨粗隆间骨折较好的方法，选择恰当的手术时机、采用正确的手术方法、术后适当的功能锻炼是取得满意疗效的关 键。

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.