掌侧传统入路与掌侧单一切口微创入路置入锁定钢板固定治疗桡骨远端骨折的疗效比较  

Comparison of palmar minimally invasive approach versus palmar traditional approach for locking plate implantation for distal radius fractures

作　　者：刘军 薛源 王鹏 吴永伟 芮永军 Liu Jun;Xue Yuan;Wang Peng;Wu Yongwei;Rui Yongjun(Department of Traumatic Orthopedics,Wuxi Ninth People's Hospital,Wuxi 214062,China)

机构地区：[1]无锡市第九人民医院创伤骨科,无锡214062

出　　处：《中华创伤骨科杂志》2024年第8期671-678,共8页Chinese Journal of Orthopaedic Trauma

基　　金：无锡市卫生健康委科技成果与适宜技术推广项目(T202147)。

摘　　要：目的比较掌侧传统入路与掌侧单一切口微创入路置入锁定钢板固定治疗桡骨远端骨折的疗效。方法回顾性分析2019年1月至2022年12月期间无锡市第九人民医院创伤骨科经掌侧入路置入锁定钢板固定治疗的116例桡骨远端骨折患者资料。男51例,女65例;年龄(57.0±10.6)岁。按切口不同分为掌侧传统入路(传统组,65例)和掌侧单一切口微创入路(微创组,51例)。记录和比较两组患者的手术时间、术中出血量、切口长度、切口愈合情况、骨折愈合时间、术后第1天和第7天疼痛视觉模拟评分(VAS)及末次随访时腕活动范围、患侧握力及影像学结果。末次随访时采用腕关节患者自行评估量表(PRWE)和Gartland-Werley腕评分评价腕功能。结果两组患者术前一般资料比较差异均无统计学意义(P>0.05),具有可比性。术后所有患者获(13.6±2.1)个月随访。微创组患者术中出血量[(27.3±3.6)mL]显著少于传统组[(41.2±6.8)mL],切口长度[(1.6±0.1)cm]显著短于传统组[(6.6±0.6)cm],术后第7天疼痛VAS评分[(2.3±0.6)分]和并发症发生率(2.0%,1/51)均显著低于传统组[(3.0±0.6)分、12.3%(8/65)],但手术时间[(70.4±6.9)min]显著长于传统组[(67.2±8.0)min],差异均有统计学意义(P<0.05)。两组患者切口愈合、骨折愈合时间、术后第1天VAS评分及末次随访时腕活动范围、患侧握力、PRWE评分、Gartland-Werley功能恢复、骨折对位、掌倾角、尺偏角和桡骨茎突长度等比较,差异均无统计学意义(P>0.05)。结论掌侧传统入路与掌侧单一切口微创入路置入锁定钢板固定均是治疗桡骨远端骨折的有效方法,但后者在切口美观性、术中出血量、手术创伤反应和手术风险等方面均优于前者。ObjectiveTo compare the palmar minimally invasive approach by a single incision versus palmar traditional approach for implantation of a locking plate in the treatment of distal radius fractures.MethodsA retrospective analysis was conducted of the 116 patients with distal radius fracture who had been treated with locking plates implanted through a palmar approach at Department of Traumatic Orthopedics,Wuxi Ninth People's Hospital from January 2019 to December 2022.There were 51 males and 65 females aged(57.0±10.6)years.According to the difference in palmar approach,they were divided into a traditional group of 65 cases treated with a traditional palmar approach and a minimally invasive group of 51 cases treated with a minimally invasive palmar approach through a single 1.5 cm incision.The surgical time,intraoperative bleeding,incision length,incision healing,fracture healing time,pain visual analogue scale(VAS)on the 1st and 7th days after surgery,range of motion and grip strength of the affected wrist,and imaging results at the last follow-up were recorded and compared between the 2 groups.The patient rated wrist evaluation(PRWE)and Gartland-Werley wrist evaluation were used to assess functional recovery of the wrist affected at the last follow-up.ResultsThere was no statistically significant difference in the baseline data between the 2 groups,indicating comparability(P>0.05).All patients were followed-up for(13.6±2.1)months.All fractures healed.The intraoperative bleeding[(27.3±3.6)mL]in the minimally invasive group was significantly less than that in the traditional group[(41.2±6.8)mL],the incision length[(1.6±0.1)cm]in the former was significantly shorter than that in latter[(6.6±0.6)cm],the postoperative VAS for pain on the 7th day after surgery[(1.8±0.8)points]and incidence of complications[2.0%(1/51)]in the former were significantly lower than those in the latter[(3.0±0.6)points,12.3%(8/65)](P<0.05).However,the surgical time[(70.4±6.9)min]in the former was significantly longer than that in the la

关 键 词：桡骨骨折 外科手术 微创性 骨折固定术 内 手术入路 

分 类 号：R687.3[医药卫生—骨科学]