改良Henry入路掌侧解剖锁定钢板固定治疗桡骨远端不稳定性骨折  

Treatment of unstable distal radius fracture with palmar locking plate via modified Henry approach

作　　者：庞飞[1] 严世贵[1] 郦仕杰 梁文清[3] 

机构地区：[1]浙江大学附属第二医院骨科,浙江杭州330100 [2]浙江中医药大学 [3]绍兴市人民医院骨科

出　　处：《上海医学》2014年第12期1052-1056,共5页Shanghai Medical Journal

基　　金：浙江省自然科学基金项目(LY13H060005);浙江省医药卫生一般研究计划项目(2012KYB213);绍兴市公益性研究计划项目(2013B70081)资助

摘　　要：目的探讨改良Henry入路掌侧解剖锁定钢板治疗桡骨远端不稳定性骨折的临床效果。方法选取2012年2月-2013年3月间由浙江大学附属第二医院收治的桡骨远端不稳定性骨折患者66例，按随机数字表法分入改良Henry入路组（35例）和传统Henry入路组（31例），采用Dienst腕关节功能评估标准和改良McBride腕关节功能评估标准评价术后患侧腕关节功能，并观察两组并发症情况。结果术后所有患者伤口均I期愈合，均获随访，随访时间9～19个月，平均随访时间为（13．5±2．7）个月。术后6个月，X线摄片检查显示，两组患者的桡骨远端关节面均平整，桡骨无轴向短缩，无内固定物失效、创伤性关节炎、骨折延迟愈合和骨折不愈合发生。改良Henry入路组Dienst腕关节功能评估的优良率为94．3％（33／35），与传统Henry入路组的90．3％（28／31）比较，差异无统计学意义（P〉0．05）。改良Henry入路组改良McBride腕关节功能评估的优良率为91．4％（32／35），与传统Henry入路组的87．1％（27／31）比较，差异无统计学意义（P〉0．05）。术后改良Henry入路组掌侧屈肌腱激惹、腕关节酸痛、正中神经刺激症的发生率分别为0、5．7％（2／35）、0，均显著低于传统Henry入路组的16．1％（5／31）、12．9％（4／31）、6．5％（2／31，P值均〈0．05）。结论改良Henry入路掌侧解剖锁定钢板治疗桡骨远端不稳定性骨折，对旋前方肌损伤小，并发症少，骨折复位固定满意，术后腕关节功能恢复良好，值得临床推广。Objective To evaluate the clinical outcome of internal fixation with palmar locking plate via modified Henry approach for unstable distal radius fracture. Methods Between February 2012 and March 2013, 66 patients with distal radius fracture were treated by modified Henry approach （n = 35） and ordinary Henry approach （n = 31） according to a random digits table. Dienst criteria and modified McBride criteria were used to evaluate the wrist joint function during follow-up. Postoperative complications were recorded. Results The average follow-up period was （ 13.5±2.7） months （range, 9-19 months）. X-ray showed that bony healing achieved in all patients 6 months postoperatively. No radial axial shortening, loosening of implants, traumatic arthritis, delayed union or nonunion occurred during the follow-up period. Dienst criteria results showed that the good rate of wrist joint function was 94.3% （33/35） in modified Henry group and 90.3% （28/31） in ordinary Henry group. Modified McBride criteria results showed that the excellent rate of wrist joint function was 91.4% （32/35） in modified Henry group and 87. 1% （27/31） in ordinary Henry group. There were no significant differences between the two groups regarding Dienst or modified McBride evaluation result （P〉0.05）. However, the incidences of palmar flexor tendon irritation symptoms, wrist joint ache and median nerve injury were 0, 5.7 % （2/35）, 0 in modified Henry group, respectively, which were significantly lower than those in the ordinary Henry group （16.1% [5/31], 12.9% [4/31], 6.5% [2/31], all P〈0.05）. Conclusion Unstable distal radius fracture can be effectively treated with palmar locking plate via modified Henry approach. There are less pronator quadratus injury, fewer complications, more satisfactory reduction and internal fixation, and rapid wrist joint reconstruction during the procedure. （Shanghai Med J, 2014, 37： 1052-1056）

关 键 词：桡骨远端骨折 内内固定术 手术入路 

分 类 号：R687.3[医药卫生—骨科学]