不同尺骨短缩截骨方法治疗尺骨撞击综合征

发布时间：2018-06-30 02:40

本文选题：尺骨 + 短缩截骨术　；参考：《华北理工大学》2015年硕士论文

【摘要】：目的探讨尺骨远端横形截骨、梯形截骨及干骺端斜形截骨三种不同短缩截骨方法在治疗尺骨撞击综合征方面的临床疗效。方法分析华北理工大学附属骨科医院在2010年1月至2014年1月采用三种不同短缩截骨方法治疗的尺骨撞击综合征患者共44例,将患者分为3组,其中尺骨远端横形截骨组(A组)13例,尺骨远端梯形截骨组(B组)15例,尺骨远端干骺端斜形截骨组(C组)16例。于围手术期分别记录三组患者的切口长度、手术所需时间及术中出血量;比较三组患者术前、术后尺骨变异情况、Mayo评分变化情况、截骨断端愈合时间及VAS评分变化情况,用于评估三种不同尺骨短缩截骨方法对尺骨撞击综合征患者的症状改善程度及手术疗效。结果1术前A、B、C三组病人在性别、病程、侧别、年龄、尺骨变异情况、临床症状与体征方面均未见显著性差异(P0.05),具有可比性。2A、B、C三组病人术后腕关节疼痛程度、功能状态、活动范围、握力评分均高于术前,Mayo总评分由术前的30(25,35.25)上升为术后的90(85,93.75),患者术后症状缓解,差异具有统计学意义(P0.05)。3 A、B、C三组病人术后尺骨阳性变异率明显低于术前,由术前的93.81%降至术后的6.81%,差异具有统计学意义(P0.05)。术后尺骨变异值明显低于术前,由术前平均(0.35±0.21)cm变为术后平均(-0.30±0.13)cm,尺骨阳性变异情况得到明显改善,差异具有统计学意义(P0.05)。4 A、B、C三组病人在切口长度、手术所需时间、截骨断端愈合时间上相比较,差异具有统计学意义(P0.05)。C组在手术切口长度、手术时间、截骨断端愈合时间上均优于A与B两组。A、B、C三组病人均在上肢止血带下操作,术中出血量上未见显著性差异(P0.05)。5 A、B、C三组病人术后3个月VAS评分低于术前,术后6个月VAS评分低于术后3个月,差异均具有统计学意义(P0.05),患者尺侧腕痛症状缓解。术前、术后3个月、术后6个月VAS评分相比较,C组低于A与B组,差异具有统计学意义(P0.05),C组在远期腕痛的缓解方面优于A、B两组。结论三种不同短缩截骨方法用于治疗尺骨撞击综合征均可获得满意疗效。通过对比,尺骨远端干骺端截骨法在切口长度、手术所需时间、截骨断端愈合时间及远期腕痛的缓解方面均优于其它两种短缩截骨方法,不仅手术切口短,操作简单,截骨断端愈合快,还可以在术中查看并修补损伤的三角纤维软骨盘,减轻因三角纤维软骨损伤而引起的疼痛,是一种比较理想的治疗尺骨撞击综合征的方法。
[Abstract]:Objective to investigate the clinical effect of three different short osteotomy methods: transverse osteotomy trapezoid osteotomy and metaphyseal oblique osteotomy in the treatment of ulnar impingement syndrome. Methods from January 2010 to January 2014, 44 patients with ulnar impingement syndrome treated with three different short osteotomy methods were analyzed and divided into 3 groups. There were 13 cases in distal ulnar transverse osteotomy group (A group), 15 cases in distal ulnar trapezoid osteotomy group (B group) and 16 cases in distal ulnar metaphyseal oblique osteotomy group (C group). The length of incision, the time required for operation and the amount of blood lost during the operation were recorded during the perioperative period, and the changes of the Mayo score, the healing time of the osteotomy end and the VAS score were compared between the three groups before and after operation. To evaluate the degree of symptom improvement and surgical efficacy of three different ulnar shortening osteotomy methods in patients with ulnar impingement syndrome. Results 1there was no significant difference in sex, course of disease, side type, age, ulna variation, clinical symptoms and signs among the three groups of patients before operation (P0.05). The range of activity and the total score of grip strength were higher than those of the preoperative Mayo score from 30 (25 / 35.25) to 90 (85 / 93.75). The postoperative symptoms were relieved, and the difference was statistically significant (P0.05). The positive variation rate of ulna in the three groups was significantly lower than that before operation. From 93.81% before operation to 6.81% after operation, the difference was statistically significant (P0.05). The variation of ulna was significantly lower than that before operation, from (0.35 卤0.21) cm before operation to (-0.30 卤0.13) cm after operation. The positive variation of ulna was significantly improved. The difference was statistically significant (P0.05). There was significant difference in the healing time of the cut end between the two groups (P0.05). The operative incision length, operation time and healing time of the osteotomy end in group C were better than those in group A and group B all operated under the tourniquet of upper limb. There was no significant difference in the amount of intraoperative bleeding (P0.05). The VAS score in the three groups was lower than that in the preoperative group 3 months after operation, and the VAS score in 6 months after operation was lower than that in the postoperative 3 months. The difference was statistically significant (P0.05), and the symptoms of ulnar carpal pain were relieved. The VAS score of group C was lower than that of group A and group B before operation, 3 months after operation and 6 months after operation, and the difference was statistically significant (P0.05) the relief of long-term wrist pain in group C was better than that in group A and B (P0.05). Conclusion three different short osteotomy methods can be used to treat ulnar impingement syndrome. By comparison, the distal ulnar metaphyseal osteotomy was superior to the other two methods in incision length, operation time, healing time and long-term relief of wrist pain, which was not only short incision, but also simple to operate. It is an ideal method to treat ulnar impingement syndrome because of the quick healing of the broken end of the osteotomy and the repair of the injured triangular fibrochondral disc during the operation to alleviate the pain caused by the injury of the triangular fibrous cartilage.
【学位授予单位】：华北理工大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R687.3

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