桡骨远端骨折合并三角软骨损伤手术效果的相关因素△（开放获取）

Factors associated with clinical consequence of surgical treatment of distal radius fractures complicated with triangular fibrocartilage complex tear

摘要:

[目的] 探讨镜下治疗桡骨远端骨折合并三角软骨 （triangular fibrocartilage complex, TFCC） 损伤的相关因素。[方法]回顾性分析 2021 月—2023 年 12 月山东大学齐鲁医院德州医院收治的镜下治疗的 152 例桡骨远端骨折合并 TFCC 损伤患者的临床资料，依据末次随访 Gartland Werley 腕关节功能评分结果分成良好组和不佳组，单因素和多因素逻辑回归分析影响镜下治疗临床结果的相关因素。[结果]152 例患者综合评定临床结果，良好 120 例，占 79.0%，不佳 32 例，占 21.0%。良好组年龄 [(58.8±10.2) 岁 vs (65.3±9.8) 岁, P=0.002] 显著低于不佳组，Palmar 分型复杂程度显著低于不佳组 [IA/IB/IC/ID/复合, (17/53/1/ 39/10) vs (3/6/1/5/17), P＜0.001]，术前尺偏角 [(19.4±2.0)° vs (15.0±1.9)°, P＜0.001] 以及掌倾角 [(-10.6±2.6)° vs (-13.2±2.5)°, P＜0.001] 显著大于不佳组。两组性别、BMI、ASA 评级、吸烟史、饮酒史、高血压史、糖尿病史、肝病史、肾病史、损伤至手术时间、 桡骨茎突高度、手术时间、TFCC 修复方法、术后固定时间比较的差异均无统计学意义 （P＞0.05）。多元逻辑回归分析结果显示，年龄大 （OR=9.219, P=0.002）、Palmar 分型复杂 （OR=2.024, P＜0.001） 为临床结果不良的危险因素。而术前尺偏角大 （OR=0.302, P＜0.001）、掌倾角大 （OR=0.665, P＜0.001） 为临床结果不良的保护因素。[结论] 年龄、Palmar 分型、术前尺偏角以及掌倾角是影响镜下治疗桡骨远端骨折合并三角软骨损伤疗效的主要因素，需要临床结合上述因素开展针对性干预，以提升患者疗效，促进功能恢复。

Abstract:

[Objective] To search the factors related to clinical outcomes of open reduction and internal fixation (ORIF) combined with arthroscopic repair for distal radius fracture complicated with triangular fibrocartilage complex (TFCC) tear. [Methods] A retrospective research was done on 152 patients who had distal radius fractures complicated with triangular fibrocartilage complex (TFCC) tear treated by ORIF and arthroscopic repair in Dezhou Branch Qilu Hospital, Shandong University from 2021 to December 2023. Based on GartlandWerley wrist score at the last follow-up, the patients were divided into good group and poor group. Univariate comparison and logistic multivariate regression analysis were conducted to analyze the factors related to the clinical outcome. [Results] The 152 patients were comprehensively marked in term of clinical results at the latest follow-up, 120 (79.0%) patients fall into the good group, while the remaining 32 (21.0%) were into the poor group. The good group proved significantly younger than the poor group in term of age [(58.8±10.2) years vs (65.3±9.8) years, P=0.002]. In addition, the former had significantly less complexity in term of Palmar classification than the latter group [IA/IB/IC/ID/compound, (17/53/1/39/10) vs (3/6/1/5/17), P＜0.001]. Moreover, the good group was significantly greater than the poor group regarding the preoperative ulnar inclination [(19.4±2.0)° vs (15.0±1.9)°, P＜0.001] and volar tilt [(-10.6±2.6)° vs (-13.2±2.5)°, P＜0.001]. However, there were no significant differences in terms of gender, BMI and ASA scale, as well as smoking, drinking, hypertension, diabetes, liver disease, kidney disease history, and interval from injury to operation, radial styloid height, operation time, TFCC repair method, and postoperative fixation time between the two groups (P＞0.05). As results of multiple logistic regression, the advanced age (OR=9.219, P= 0.002) and complex Palmar classification (OR=2.024, P＜0.001) were risk factors for poor clinical outcomes, while greater ulnar inclination (OR=0.302, P＜0.001) and greater volar tilt (OR=0.665, P＜0.001) were protective factors for poor outcomes. [Conclusion] Age, Palmar clas-sification, preoperative ulnar inclination and volar tilt are the main factors affecting surgical outcome of distal radius fracture complicated with TFCC tear, and targeted intervention aiming the abovesaid factors is needed to improve the therapeutic consequece and promote functional recovery. distal radius fracture, triangular fibrocartilage complex injury, open reduction and internal fixation, wrist arthroscopy, influencing factors