不同入路锁定钢板内固定治疗不稳定型桡骨远端骨折效果及对腕关节功能恢复和生活质量影响  

Efficacy of Different Approaches of Locking Plate Internal Fixation in Treatment of Patients with Unstable Distal Radius Fractures and Its Effects on Recovery of Wrist Function and Quality of Life

作　　者：王振旺[1] 李立东[1] 郑秋涛[1] 梁卫东[1] WANG Zhen-wang;LI Li-dong;ZHENG Qiu-tao;LIANG Wei-dong(Department of Traumatic Surgery,the Second Hospital of Tangshan City,Tangshan,Hebei 063000,China)

机构地区：[1]唐山市第二医院创伤科,河北唐山063000

出　　处：《临床误诊误治》2021年第7期65-70,共6页Clinical Misdiagnosis & Mistherapy

基　　金：河北省医学科学研究重点课题计划项目(20160814)。

摘　　要：目的探讨不同入路锁定钢板内固定治疗不稳定型桡骨远端骨折的效果及对腕关节功能恢复和生活质量的影响。方法选取2017年1月-2018年1月收治的不稳定型桡骨远端骨折105例,根据手术入路不同将其分为观察组(54例)和对照组(51例)两组,观察组行掌侧入路锁定钢板内固定治疗,对照组行背侧入路锁定钢板内固定治疗。比较两组术前及术后3 d桡骨远端解剖学参数,围术期指标,术后6个月Gartland-wreley腕关节功能评分,术前及术后6个月健康调查简表(SF-36)评分,以及术后6个月内并发症发生情况。结果术后3 d,两组掌倾角、尺偏角和桡骨高度均较术前改善,差异有统计学意义(P<0.01)。两组术后3 d掌倾角、尺偏角、桡骨高度和手术时间、术中出血量、术后愈合时间比较差异均无统计学意义(P>0.05)。术后6个月,Gartland-wreley腕关节功能评分优良率观察组为92.59%高于对照组74.51%;SF-36评分两组均较术前升高,且观察组高于对照组,差异有统计学意义(P<0.05或P<0.01)。术后6个月内,总并发症发生率观察组为9.26%低于对照组23.53%,差异有统计学意义(P<0.05)。结论掌侧和背侧入路锁定钢板内固定治疗不稳定型桡骨远端骨折均有一定效果,但掌侧入路在促进术后腕关节功能恢复、提高术后生活质量及减少术后并发症发生方面更具优势。Objective To investigate efficacy of different approaches of locking plate internal fixation in treatment of patients with unstable distal radius fractures and its effects on recovery of wrist function and quality of life.Methods A total of 105 patients with unstable distal radius fractures admitted between January 2017 and January 2018 were selected and divided into observation group(n=54)and control group(n=51)according to different surgical approaches.Observation group was treated with locking plate internal fixation via volar approach,while control group was treated with locking plate internal fixation via dorsal approach.Anatomical parameters of distal radius before and after operation for 3 d,perioperative indexes,Gartland wreley score for wrist function after operation for 6 months,the MOS item short from health survey(SF-36)score before and after operation for 6 months and incidence rate of complications after operation for 6 months were compared between two groups.Results After operation for 3 d,heights of palmar inclination angle,ulnar deviation angle and radial were significantly improved compared with those before treatment in two groups(P<0.01).There were no significant differences in values of palmar inclination angle,ulnar deviation angle and radial height after operation for 3 d,intraoperative volume of blood loss and postoperative healing time between two groups(P>0.05).After operation for 6 months,the excellent and good rate of Gartland wreley score for wrist function in observation group(92.59%)was significantly higher than 74.51%in control group;SF-36 scores were significantly higher than those before operation in two groups,and the score in observation group was significantly higher than that in control group(P<0.05 or P<0.01).After operation for 6 months,the total incidence rate of complications in observation group(9.26%)was significantly lower than 23.53%in control group(P<0.05).Conclusion Volar approach and dorsal approach are effective in treatment of patients with unstable distal radius

关 键 词：桡骨骨折 锁定钢板内固定 掌侧入路 背侧入路 腕关节功能 生活质量 术后并发症 

分 类 号：R683.41[医药卫生—骨科学]