腕关节镜辅助切开复位内固定治疗桡骨远端关节内骨折的疗效  

Efficacy of arthroscopically-assisted open reduction and internal fixation of intra-articular distal radius fracture

作　　者：张炯豪 尹华伟 邱彦群[1,2] 王海鹏 沈云东[1,2] 徐文东[1,2] Zhang Jionghao;Yin Huawei;Qiu Yanqun;Wang Haipeng;Shen Yundong;Xu Wendong(Limb Function Peconstruction Center,Jing′an District Central Hospital,Fudan University,Shanghai 200040,China;Department of Hand Surgery,Huashan Hospital,Fudan University,Shanghai 200040,China;Department of Orthopedics and Hand Surgery,First Affiliated Hospital,Fujian Medical University,Fuzhou 350005,China)

机构地区：[1]复旦大学附属静安区中心医院肢体功能重建中心,上海200040 [2]复旦大学附属华山医院手外科,上海200040 [3]福建医科大学附属第一医院骨科与手外科,福州350005

出　　处：《中华创伤杂志》2022年第3期227-233,共7页Chinese Journal of Trauma

基　　金：国家自然科学基金(81801941,81525009,81830063);上海市重中之重临床医学中心项目(2017ZZ01006);上海市卫生和计划生育委员会项目(20164Y0018);复旦大学-SIBET医学工程联合基金(YG2017-012);上海市“科技创新行动计划”医学创新研究专项(21Y11902900)。

摘　　要：目的:探讨腕关节镜辅助切开复位内固定治疗桡骨远端关节内骨折的疗效。方法:采用回顾性队列研究分析2017年6月至2020年8月复旦大学附属静安区中心医院收治的44例桡骨远端关节内骨折患者的临床资料,其中男13例,女31例;年龄35~85岁[(62.5±12.9)岁]。骨折AO/OTA分型:B型7例,C型37例。所有患者均行切开复位掌侧钢板内固定,22例采用关节镜辅助治疗(关节镜组),22例采用传统术中透视治疗(透视组)。记录两组手术时间,关节镜组术中三角纤维软骨复合体(TFCC)损伤及骨折移位情况。比较两组术后12个月腕关节功能患者自行评估量表(PRWE)评分、上肢功能评定表(DASH)评分,以及腕关节活动范围。观察并发症发生情况。结果:患者均获随访12~15个月[(13.3±1.1)个月]。关节镜组手术时间为(104.0±40.5)min,长于透视组的(71.3±32.1)min(P<0.05)。关节镜组术中诊断TFCC损伤14例(64%),关节镜直视下见骨折移位间隙为0.8(0.3,0.8)mm,台阶为1.0(0.3,1.5)mm,关节镜辅助复位后分别为0.3(0.0,0.5)mm、0.5(0.0,0.5)mm(P均<0.05)。术后12个月关节镜组PRWE评分为(9.8±4.9)分,低于透视组的(13.4±5.8)分(P<0.05)。关节镜组DASH评分为(9.0±5.0)分,低于透视组的(13.0±6.1)分(P<0.05)。关节镜组腕关节背伸和旋后分别为(73.8±8.9)°和(82.5±8.0)°,高于透视组的(65.8±14.2)°和(76.3±10.4)°(P均<0.05)。两组术后未出现螺钉松动或断裂、血管神经损伤、切口感染及创伤性关节炎等并发症。结论:腕关节镜辅助切开复位内固定治疗桡骨远端关节内骨折可增加关节面复位的准确性,改善术后腕关节功能,同时术中能明确诊断TFCC是否存在损伤。Objective To investigate the effect of arthroscopically-assisted open reduction and internal fixation of intra-articular distal radius fracture.Methods A retrospective cohort study was made on clinical data of 44 patients with distal radial intraarticular fracture admitted to Jing′an District Central Hospital,Fudan University between June 2017 and August 2020.There were 13 males and 31 females,at age of 35-85years[(62.5±12.9)years].According to AO/OTA fracture classification system,there were 7 patients with type B and 37 with type C.Open reduction and internal fixation with volar plate was used in all patients,among which 22 were operated on using arthroscopy assistance(arthroscopy group)and 22 were operated on with traditional intraoperative fluoroscopy(fluoroscopy group).The operation time in both groups and triangular fibrocartilage complex(TFCC)injury and fracture displacement in arthroscopy group were recorded.Patient-rated wrist evaluation(PRWE)score,disabilities of the arm,shoulder and hand(DASH)questionnaire and range of wrist motion were compared between the two groups at 12 months after operation.The incidence of complications was observed.Results All patients were followed up for 12-15 months[(13.3±1.1)months].The operation time in arthroscopy group was(104.0±40.5)minutes,longer than(71.3±32.1)minutes in fluoroscopy group(P<0.05).In arthroscopy group,14 patients(64%)with TFCC injury were diagnosed intraoperatively,with the fracture displacement gap and step for 0.8(0.3,0.8)mm and 1.0(0.3,1.5)mm under arthroscopic vision,which were reduced to 0.3(0.0,0.5)mm and 0.5(0.0,0.5)mm after arthroscopically-assisted reduction(all P<0.05).The PRWE score in arthroscopy group was(9.8±4.9)points at 12 months after operation,lower than(13.4±5.8)points in fluoroscopy group(P<0.05).The DASH questionnaire in arthroscopy group was(9.0±5.0)points at 12 months after operation,lower than(13.0±6.1)points in fluoroscopy group(P<0.05).The dorsal extension and posterior rotation of the wrist in arthroscopy group were

关 键 词：关节镜 桡骨骨折 骨折固定术 内 术中复位 

分 类 号：R687.3[医药卫生—骨科学]