改良单一掌侧15 mm切口微创入路置入锁定钢板治疗B3型桡骨远端骨折的疗效  

Therapeutic efficacy of modified locking plate implantation through single minimally invasive volar approach of 15 mm for type B3 distal radius fractures

作　　者：刘军 刘浩 王鹏 薛源 罗俊浩 芮永军 Liu Jun;Liu Hao;Wang Peng;Xue Yuan;Luo Junhao;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：《中华创伤杂志》2024年第12期1107-1113,共7页Chinese Journal of 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：目的探讨改良单一掌侧15 mm切口微创入路置入锁定钢板治疗B3型桡骨远端骨折的疗效。方法采用回顾性病例系列研究分析2021年2月至2024年1月无锡市第九人民医院收治的14例B3型桡骨远端骨折患者的临床资料,其中男6例,女8例;年龄21~78岁[(50.9±15.5)岁]。通过改良单一掌侧15 mm切口微创入路插入锁定钢板,再复位及临时固定骨折,透视下进一步调整复位并最终固定治疗。观察手术结束和末次随访时切口长度。术后3 d根据CT检查,评估关节面骨折复位质量。观察骨折愈合情况,并记录骨折愈合时间。比较术前和术后7、14 d及末次随访时视觉模拟评分(VAS);术前和术后第3、6个月及末次随访时握力、腕关节活动范围(屈‑伸、旋前‑旋后和尺‑桡偏)、腕关节Gartland‑Werley功能评分。观察术后并发症发生情况。结果患者均获随访6~34个月[(17.1±5.2)个月]。手术结束时切口长度为(20.3±6.9)mm,末次随访时为(19.1±6.3)mm。术后3 d根据CT检查,关节面骨折复位优9例,良4例,可1例,优良率92.9%。骨折均愈合,愈合时间为5~8周[(5.9±0.6)周]。术后7、14 d及末次随访时VAS分别3.0(3.0,4.0)分,3.0(2.0,3.0)分和0.0(0.0,1.0)分,均显著低于术前的5.0(3.8,6.0)分(P<0.01),且随术后时间延长逐渐降低(P<0.05)。术后第3、6个月及末次随访时握力[(72.1±5.3)%、(78.9±4.0)%、(82.9±4.8)%]、腕关节屈‑伸范围[(76.6±3.3)°、(80.9±3.6)°、(82.3±3.6)°]、腕关节旋前‑旋后范围[(159.4±5.7)°、(172.1±6.2)°、(173.9±3.7)°]、腕关节尺‑桡偏范围[(35.8±3.9)°、(37.6±4.0)°、(38.3±3.5)°]、腕关节Gartland‑Werley功能评分[7.0(2.8,8.0)分、2.0(2.0,4.5)分、2.0(2.0,2.0)分],均较术前[(63.4±8.0)%、(74.9±5.4)°、(150.6±10.3)°、(32.7±4.9)°、18.0(16.8,20.0)分]显著改善(P<0.05),且腕关节活动范围随术后时间延长逐渐改善(P<0.05),握力和腕关节Gartland-Werley功能评分在术后3、6个月显著�Objective To explore the therapeutic efficacy of type B3 distal radius fractures treated with modified locking plate implantation through single minimally invasive volar Methods approach of 15 mm.A retrospective case series study was conducted to analyze the clinical data of 14 patients with type B3 distal radius fractures admitted to Wuxi Ninth People′s Hospital from February 2021 to January 2024,including 6 males and 8 females,aged 21‑78 years[(50.9±15.5)years].The steel plate was inserted first through single minimally invasive volar approach of 15 mm,followed by reduction and temporary fixation of the fractures.Further adjustment of the reduction and final fixation were performed under fluoroscopy.The length of the incision was observed at the end of the surgery and at the last follow‑up.The observed and the healing time was recorded.The visual analogue scale(VAS)scores before surgery and at 7,14 days after surgery and at the last follow‑up were compared.The grip strengths,range of motions of the wrist joint(flexion‑extension,pronation‑supination and ulnar‑radial deviation),and Gartland‑Werley wrist scores at 3,6 months after surgery and at the last follow‑up were detected.The occurence of postoperative complications was observed.Results All the patients were followed up for 6‑34 months[(17.1±5.2)months].The incision length was(20.3±6.9)mm at the end of the surgery and was(19.1±6.3)mm at the last follow‑up.As shown in CT scan at postoperative 3 days,excellent reduction of the articular surface was observed in 9 patients,good in 4 and fair in 1,with an excellent and good rate of 92.9%.The fractures were all healed,with the healing time of 5‑8 weeks[(5.9±0.6)weeks].At 7,14 days after surgery and at the last follow‑up,the VAS scores were 3.0(3.0,4.0)points,3.0(2.0,3.0)points and 0.0(0.0,1.0)points respectively,significantly lower than 5.0(3.8,6.0)points before surgery(P<0.01),and the VAS scores significantly decreased over time after surgery(P<0.05).At 3,6 months after surgery and

关 键 词：桡骨骨折 骨折固定术 内 外科手术 微创性 

分 类 号：R687.3[医药卫生—骨科学]