三种入路掌侧钢板置入治疗不稳定桡骨远端骨折的比较  

Comparison of three kinds of palmar approach plate implantation for treatment of unstable distal radius fractures

作　　者：黄晓夏 彭聪 艾科拜尔·喀迪尔 滕勇 赵岩[3] Huang Xiaoxia;Peng Cong;Aikobayer·Kudir;Teng Yong;Zhao Yan(Xinjiang Medical University,Urumqi 830054,Xinjiang Uygur Autonomous Region,China;Department of Spine Surgery,General Hospital of People’s Liberation Army Xinjiang Military Region,Urumqi 830099,Xinjiang Uygur Autonomous Region,China;Department of Orthopedics,First Affiliated Hospital of Xinjiang Medical University,Urumqi 830011,Xinjiang Uygur Autonomous Region,China;Sixth Affiliated Hospital of Xinjiang Medical University,Urumqi 830092,Xinjiang Uygur Autonomous Region,China)

机构地区：[1]新疆医科大学,新疆维吾尔自治区乌鲁木齐市830054 [2]中国人民解放军新疆军区总医院脊柱外科,新疆维吾尔自治区乌鲁木齐市830099 [3]新疆医科大学第一附属医院骨科,新疆维吾尔自治区乌鲁木齐市830011 [4]新疆医科大学第六附属医院,新疆维吾尔自治区乌鲁木齐市830092

出　　处：《中国组织工程研究》2024年第24期3867-3872,共6页Chinese Journal of Tissue Engineering Research

摘　　要：背景:既往治疗桡骨远端骨折术中需切断旋前方肌,修复旋前方肌失败会带来一系列并发症。目的:探讨不同入路保留旋前方肌联合掌侧钢板治疗桡骨远端骨折的临床疗效。方法:回顾性纳入66例桡骨远端骨折患者的临床资料,按不同入路分为传统Henry入路组(A组)、劈开肱桡肌腱入路(B组)、旋前方肌后方入路(C组),每组22例。观察3组患者术后内固定、骨折愈合及术后并发症发生情况;比较3组患者术后腕关节疼痛目测类比评分及前臂旋转角度;Dienst关节量表用于评估患者的手腕功能。结果与结论:①B、C组患者的手术时间、术中出血量、骨折愈合时间上均显著少于A组(P<0.01),B组和C组术中出血量及骨折愈合时间相比则无显著差异,但B组手术时间更短;②术后3 d及1,3个月行腕关节正侧位X射线片检查,3组患者桡骨高度、掌倾角、尺偏角相比无显著差异(P>0.05),3组同一时期各指标相比无显著差异(P>0.05);③术后12个月随访时,3组目测类比评分和前臂旋转角度均无显著差异;但术后1,3个月的评估结果显示,3组之间的目测类比评分和前臂旋转角度差异均有显著性意义(P<0.05),其中C组目测类比评分更低,前臂旋转角度更大;④依据Dienst关节评分标准,术后12个月A、B、C组患者腕关节功能评估优良率分别为86%(19/22)、91%(20/22)、95%(21/22);⑤所有患者术后均未出现血管、神经损伤及术区感染,A组出现肌腱激惹3例、创伤性关节炎2例、腕管综合征2例;B组出现肌腱激惹1例、关节僵硬1例;C组出现创伤性关节炎、腕管综合征各1例;⑥提示不同手术方法治疗桡骨远端骨折均可获得良好的临床效果;将钢板放置在旋前方肌下方可以减轻术后早期疼痛,促进早期活动,恢复正常生活;肱桡肌腱入路在术中骨折暴露方面更有优势,可以缩短手术时间。BACKGROUND:In the past,it was necessary to cut off the pronator quadratus muscle in the treatment of distal radius fractures.Failure to repair the pronator quadratus muscle can lead to a series of complications.OBJECTIVE:To explore the clinical efficacy of different methods of preserving the pronator quadratus muscle combined with a palmar steel plate in the treatment of distal radius fractures.METHODS:Clinical data of 66 patients with distal radius fractures were retrospectively included,divided into the traditional Henry approach group(group A),the split brachioradialis tendon approach group(group B),and the posterior pronator quadratus muscle approach group(group C),with 22 patients in each group.Postoperative internal fixation,fracture healing,and postoperative complications were observed in the three groups.The visual analog scale score of postoperative wrist pain and forearm rotation angle were compared among the three groups.The Dienst Joint Scale was used to evaluate the wrist function of patients.RESULTS AND CONCLUSION:(1)The surgical time,intraoperative blood loss,and fracture healing time of groups B and C were significantly lower than those of group A(P<0.01).There was no significant difference in intraoperative blood loss and fracture healing time between groups B and C,but the surgical time was shorter in group B.(2)The anteroposterior and lateral wrist X-ray examination 3 days and 1 and 3 months after surgery exhibited that there were no significant differences in radial height,palm angle,and ulnar deviation angle among the three groups(P>0.05).No significant difference was detected in various indicators during the same phase among the three groups(P>0.05).(3)At a follow-up of 12 months after surgery,there were no significant differences in visual analog scale scores and forearm rotation angle among the three groups.However,the evaluation results at 1 and 3 months after surgery demonstrated significant differences in visual analog scale scores and forearm rotation angle among the three groups(P<0.0

关 键 词：桡骨远端骨折 Henry入路 旋前方肌 掌侧钢板 内固定 

分 类 号：R459.9[医药卫生—治疗学] R318[医药卫生—临床医学] R683