组合式撑开器在难复性桡骨远端骨折治疗中的应用  

Application of combined distractor in the treatment of refractory distal radius fractures

作　　者：张积森[1] 方家刘 谢武昆 荆珏华[1] 许新忠[1] Zhang Jisen;Fang Jialiu;Xie Wukun;Jing Juehua;Xu Xinzhong(Department of Orthopaedics,the Second Affiliated Hospital of Anhui Medical University,Hefei 230601,China)

机构地区：[1]安徽医科大学第二附属医院骨科,合肥230601

出　　处：《中华骨科杂志》2022年第5期281-289,共9页Chinese Journal of Orthopaedics

摘　　要：目的探究组合式撑开器辅助钢板内固定在难复性桡骨远端骨折治疗中的应用价值。方法回顾性分析2018年3月至2020年2月采用组合式撑开器辅助复位治疗32例难复性桡骨远端骨折患者资料,采用倾向评分匹配的方法,按照1∶1匹配设立非撑开器组,共32例患者。撑开器组男15例、女17例;年龄(54.9±15.8)岁(范围18~77岁);根据AO分型,A3型3例、B3型3例、C2型16例、C3型10例。非撑开器组男12例、女20例;年龄(59.7±14.8)岁(范围21~79岁);A3型4例、B3型5例、C2型12例、C3型11例。比较两组患者的手术时间、桡骨高度、掌倾角、尺偏角、腕关节活动度、视觉模拟评分(visual analogue scale,VAS)、上肢功能障碍评分量表(disability of arm,shoulder and hand,DASH)、改良Mayo腕部评分(modified Mayo wrist score,MMWS),并记录并发症情况。结果64例患者均顺利完成手术并获得随访,随访时间12~54个月,平均17.8个月。撑开器组手术时间为(91.2±14.6)min,低于非撑开器组的(137.6±27.3)min,差异有统计学意义(t=8.48,P<0.001);撑开器组桡骨高度为(11.5±1.4)mm,大于非撑开器组的(10.6±1.3)mm,差异有统计学意义(t=2.59,P=0.012)。末次随访时,撑开器组与非撑开器组掌倾角(7.9°±4.4°vs.7.5°±3.5°)、尺偏角(23.3°±5.7°vs.22.3°±4.5°)、腕关节掌屈(63.2°±15.3°vs.62.6°±11.1°)、背伸(63.5°±10.7°vs.62.4°±15.2°)、旋前(69.2°±11.8°vs.67.0°±11.0°)、旋后(73.1°±10.4°vs.72.0°±8.7°)、VAS评分[(0.8±0.5)分vs.(0.9±0.7)分]、DASH评分[(12.9±6.6)分vs.(13.4±7.0)分],MMWS评分[(84.1±5.8)分vs.(83.5±6.2)分]的差异均无统计学意义(P>0.05)。撑开器组1例出现伸肌健激惹症状,内固定取出后症状消失;非撑开器组2例出现腕管综合征,经切开减压治疗后好转。结论对难复性桡骨远端骨折,使用组合式撑开器辅助钢板内固定手术时间短、可达到更好的桡骨高度恢复,术后疗效满意。Objective To investigate the application of combined distractor in the treatment of refractory distal radius fractures.Methods From March 2018 to February 2020,the data of 32 patients with refractory distal radius fractures treated with combined distractor-assisted reduction were retrospectively analyzed.The propensity score matching method was used to establish a non-distractor group according to 1∶1 matching,with a total of 32 patients.In the distractor group,there were 15 males and 17 females,age 54.9±15.8 years(range,18-77).According to AO classification,3 cases were A3,3 cases were B3,16 cases were C2,10 cases were C3.In the non-distractor group,there were 12 males and 20 females,age 59.7±14.8 years,4 cases were A3,5 cases were B3,12 cases were C2 and 11 cases were C3.Main measures:surgical time,radial height,palm inclination,ulnar deviation,range of motion of the wrist,visual analogue scale(VAS),and functional assessment using disability of arm,shoulder and hand(DASH)and modified Mayo wrist score(MMWS).Results A total of 64 patients were included in this study,and all patients successfully completed the operation and were followed up for 12-54 months,with an average of 17.8 months.The operative time of the distractor group was 91.2±14.6 min,which was significantly lower than that of the non-distractor group 137.6±27.3 min,and the difference was statistically significant(t=8.48,P<0.001);the radial height in the distractor group 11.5±1.4 mm was significantly higher than that in the non-distractor group 10.6±1.3 mm,and the difference was statistically significant(t=2.59,P=0.012).At the last follow-up,there were no statistically significant differences in the palm inclination 7.9°±4.4°vs.7.5°±3.5°,ulnar deviation 23.3°±5.7°vs.22.3°±4.5°,wrist flexion 63.2°±15.3°vs.62.6°±11.1°,dorsiflexion 63.5°±10.7°vs.62.4°±15.2°,pronation 69.2°±11.8°vs.67.0°±11.0°,supination 73.1°±10.4°vs.72.0°±8.7°,VAS 0.8±0.5 points vs.0.9±0.7 points,DASH score 12.9±6.6 points vs.13.4±7.0 poin

关 键 词：桡骨骨折 骨牵引复位法 骨折固定术 

分 类 号：R687.3[医药卫生—骨科学]