经旋前方肌插入锁定接骨板治疗桡骨远端不稳定骨折的疗效分析  

Efficacy of locking plate insertion trans pronator quadratusis muscle on unstable distal radius fracture

作　　者：施凯兵 张红 施海峰 陈晔[1] 施晓健[1] 沈美华 SHI Kaibing;ZHANG Hong;SHI Haifeng;CHEN Ye;SHI Xiaojian;SHEN Meihua(Department of Orthopedics, Haimen People's Hospital, Haimen 226100,Jiangsu;Department of Hand Surgery, Ninth People's Hospital of Wuxi, Wuxi214000,Jiangsu ,China)

机构地区：[1]江苏省海门市人民医院骨科,江苏海门226100 [2]江苏省无锡市第九人民医院手外科,江苏无锡214000

出　　处：《中华骨与关节外科杂志》2018年第12期914-917,共4页Chinese Journal of Bone and Joint Surgery

摘　　要：背景:手术治疗桡骨远端不稳定骨折已是临床常用方式,术中保留旋前方肌对能否改善桡骨远端骨折的预后存在争议。目的:探讨经旋前方肌插入锁定接骨板治疗不稳定桡骨远端骨折的临床疗效。方法:回顾性研究2016年1月至2017年6月,行桡骨远端骨折切开复位掌侧锁定接骨板内固定治疗的患者共84例(男30例,女54例)。经旋前方肌插入锁定接骨板治疗的患者76例,中途因关节面或骨折断端显露不满意而改部分切开旋前方肌治疗8例(计入总例数84例)。通过手术时间,术中复位指标(桡骨高度、关节面、掌倾角、尺偏角),术后疼痛时间及程度,骨折愈合时间,前臂旋转功能,腕关节功能等指标评价疗效。结果:所有患者均在止血带下顺利完成手术,78例(不切开旋前方肌72例,部分切开6例)患者获得8~24个月随访,平均13个月左右。手术时间38~72 min,平均50 min;术后累计疼痛时间约18.5 h;疼痛程度(WHO 5级分度)0度10例,1度68例,2度6例;术后次日X线检查示,桡骨掌倾角8°~14°,平均11°,尺偏角16°~22°,平均21.8°,桡骨高度8~13 mm,平均11 mm,关节面完全恢复81例,3例关节面有台阶,台阶<2 mm;临床骨折愈合时间6.8~12周,平均约7.9周;术后8个月前臂旋转功能测定为旋前50°~60°,平均57.8°,旋后78°~88°,平均84.5°。末次随访时患者骨折均愈合,无大鱼际部位麻木,无手指屈曲受限,拇指背伸活动受限2例,骨折复位轻度丢失3例。根据Dienst标准评分评价疗效,优66,良12,可6,优良率为94%。结论:经旋前方肌插入锁定接骨板是治疗桡骨远端骨折的有效方法,有创伤小,并发症少的优点,并在术后功能恢复方面存在优势。Background: Surgical treatment of unstable distal radial fracture has been a common clinical practice. It is contro. versial whether preservation of the pronator muscle during surgery can improve the prognosis of distal radial fractures. Objec. tive: To investigate the clinical effect of locking plate insertion trans pronator quadratusis muscle in the treatment of unstable distal radius fractures. Methods: A retrospective study of 84 patients (30 males and 54 females) who underwent open reduction and volar locking plate fixation from January 2016 to June 2017 was conducted. Seventy-six patients were treated with locking plate insertion trans pronator quadratusis muscle, 8 patients were treated with partial severing pronator quadratusis muscle due to unsatisfactory joint surface or fracture end which were included in the analysis pool. The outcomes included operation time, intraoperative reduction index (tibial height, articular surface, palm tilt angle, ulnar angle), postoperative pain duration and ex. tent, fracture healing time, forearm rotation function, wrist joint function, etc. Results: All patients underwent successful opera. tion under the tourniquet. 78 patients including 72 patients keeping pronator quadratusis muscle untouched and 6 patients par. tially severing pronator quadratusis muscle were followed up for approximately 13 months (range, 8-24 months). The operation time was 38-72 minutes (average 50 minutes);the cumulative pain time was about 18.5 hours;the degree of pain (WHO grade 5), 0 degrees: 10 cases, 1 degree: 68 cases, 2 degrees: 6 cases;X-ray was reviewed the next day after surgery: radial inclina. tion: 8°-14°(average 11°), ulnar angle: 16°-22°(average 21.8°), radius height 8-13 mm (average 11 mm). The joint surface was completely restored in 81 cases, 3 cases had steps on the joint surface, and the step was <2 mm;the clinical fracture heal. ing time was 6.8-12 weeks (average about 7.9 weeks);the forearm rotation function was measured 8 months after surgery: 50°- 60°pronation (ave

关 键 词：桡骨远端骨折 旋前方肌 锁定接骨板 

分 类 号：R687.3[医药卫生—骨科学]