目的 探讨两类桡骨远端die-punch骨折的影像学特点及其区别。 方法 分析2007年1月~2016年1月诊断为die-punch骨折的498例患者临床和影像学资料，依据“三柱理论”和骨折波及部位将其分为单柱和双柱die-punch骨折两类，比较其发生率、年龄、性别、治疗方法和功能恢复等方面差异。 结果 单柱die-punch骨折的发生率、平均年龄和功能恢复优良率分别为15.66%、35.42岁和96.15%，双柱die-punch骨折分别为84.34%、54.69岁和80.00%,二者比较差异均有统计学意义（P=0.000）；单柱die-punch骨折的男女比为48/30，手术保守比为62/16，双柱die-punch骨折分别为223/197和344/76，二者比较差异均无统计学意义（分别P=0.169和P=0.613）。 结论 桡骨远端die-punch骨折是轴向暴力经月骨传递到月骨窝致月骨窝骨折的统称。因暴力性质和大小、受伤时手腕位置和患者骨质等的不同，致有单柱和双柱die-punch骨折之分，两者在分型归类、严重程度、发生机理、暴力性质和程度、发生率、年龄和预后等方面均存在明显区别。
Abstract
Objective To investigate the characteristics and differences of two kinds of die-punch fractures of the distal radius on imageology. Methods Images and clinical data of 498 cases with die-punch fractures of the distal radius from January 2007 to January 2016 were studied. According to the “three-column theory” and the location of fractures involved, die-punch fractures were divided into a single-column fracture and a double-column fracture. The differences in incidence, age, gender, treatment method and functional recovery between the two kinds of die-punch fractures were compared. Results The incidence, mean age and excellent and good rate of functional recovery of single-column fractures were 15.66%, 35.42 years old and 96.15% respectively, while as 84.34%, 54.69 years old and 80.00% respectively for double column die-punch fractures, showing significant differences between the two groups (P=0.000); the male or female ratio was 48/30, the operation or conservation ratio was 62/16 of single-column die-punch fractures, while as 223/197 as the male or female ratio and 344/76 as the operation or conservation ratio for double-column die-punch fractures, respectively, showing no significant differences between two groups (P=0.169 and P= 0.613 respectively). Conclusions Die-punch fractures of the distal radius are fractures resulting from an axial load through the lunate to the lunate fossa. However, due to different nature and size of violence, different position of wrist when injured and different bony quality of patient, resulting single-column and double-column die-punch fractures, which making significant difference in category and classification, degree of severity, occurrence mechanism, violence nature and level, incidence, age and prognosis of the fractures.
关键词
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桡骨远端骨折 /
die-punch骨折 /
三柱理论
Key words
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Fracture of distal radius /
Die-punch fracture /
Three column theory
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