“浮筏”撬拨接骨板内固定治疗不稳定桡骨远端骨折的疗效分析  

Curative effect of"floating raft"prying bone plate internal fixation in the treatment of unstable distal radius fractures

作　　者：沈影超[1] 蒋晓伟[1] 陆苇[1] 罗斌 周烨 周渊[1] SHEN Ying-chao;JIANG Xiao-wei;LU Wei;LUO Bin;ZHOU Ye;ZHOU Yuan(Department of Orthopaedics,Changshu Hospital Affiliated to Nanjing University of Traditional Chinese Medicine,Changshu Jiangsu 215500,China)

机构地区：[1]南京中医药大学附属常熟医院骨科,江苏常熟215500

出　　处：《局解手术学杂志》2021年第7期586-590,共5页Journal of Regional Anatomy and Operative Surgery

基　　金：常熟市卫生和计划生育委员会科技计划项目(csws201814)。

摘　　要：目的探讨“浮筏”撬拨、顶折捺正手法复位并行掌侧接骨板内固定术治疗不稳定桡骨远端骨折患者的临床疗效。方法选择2018年9月至2019年3月我院收治的桡骨远端骨折患者48例,将2019年1~3月的23例患者纳入观察组,利用围旋前方肌双窗口,借助术中“浮筏”撬拨、顶折捺正手法复位,采用桡骨远端斜T型接骨板掌侧内固定;将2018年9~12月的25例患者纳入对照组,采用传统切开复位内固定术治疗;观察2组患者的手术情况、腕关节功能情况、临床疗效和切口不良事件发生情况。结果观察组患者手术时间短于对照组(P<0.05);2组患者平均出血量比较,差异无统计学意义(P>0.05)。随访至术后3个月末,观察组腕关节功能减损值小于对照组,差异有统计学意义(P<0.05);根据改良的Shea评分结果,观察组临床疗效优良率高于对照组,差异有统计学意义(P<0.05)。观察组未出现切口愈合不良情况,但术后3 d出现1例切口周缘淤血患者,对照组出现3例患者切口周缘红肿的,经对症治疗后均好转;2组均未出现切口感染及切口裂开等不良事件。结论围旋前方肌双窗口入路有效保留了旋前方肌,充分掌握“浮筏”撬拨等间接复位技术,可减少手术并发症的发生,减少骨折不愈合,降低切口不良事件发生率,最大程度保留患者腕部和前臂旋转功能。Objective To investigate the clinical effect of"floating raft"prying,top folding and straightening manual reduction combined with volar bone plate internal fixation in the treatment of patients with unstable distal radius fractures.Methods A total of 48 patients with distal radius fractures admitted to our hospital from September 2018 to March 2019 were selected.Among them,23 patients from January to March 2019 were included as the observation group,who were reduced by the double windows around the pronator quadratus,the"floating raft"prying and top folding and straightening manual reduction during operation,and treated by volar internal fixation with oblique T-shaped bone plate of the distal radius.Other 25 patients from September to December 2018 were included as the control group,and they were treated with traditional open reduction and internal fixation.The surgical status,wrist joint function,clinical efficacy and adverse incision events of the two groups were observed.Results The operation time of the observation group was shorter than that of the control group(P<0.05);there was no statistically significant difference in the average blood loss between the two groups(P>0.05).Follow-up had been performed to the end of 3 months after operation,the impairment value of wrist joint function in the observation group was smaller than that in the control group,and the difference was statistically significant(P<0.05).According to the modified Shea score,the excellent and good rate of clinical efficacy in the observation group was higher than that in the control group,and the difference was statistically significant(P<0.05).There was no poor wound healing occurred in the observation group,but congestion around the incision occurred in 1 case 3 days after operation;redness and swelling around the incision occurred in 3 cases of the control group,all of which improved after symptomatic treatment.No adverse events such as incision infection or incision dehiscence occurred in the two groups.Conclusion The double window ap

关 键 词：旋前方肌 双窗口入路 桡骨远端骨折 间接复位 “浮筏”撬拨 顶折捺正手法 

分 类 号：R687.3[医药卫生—骨科学]