腕横韧带切除预防桡骨下端骨折迟发性腕管综合征的病例对照研究

Case-control study on transverse carpal ligament resection for the prevention of delayed carpal tunnel syndrome after distal radius fracture

目的:探讨桡骨下端骨折采用掌侧切口切开复位"T"形钢板内固定并Ⅰ期行腕横韧带切除对术后发生迟发性腕管综合征的预防作用。方法:自2000年3月至2007年3月,桡骨下端骨折患者采用两种方法治疗。采用切开复位"T"形钢板内固定并Ⅰ期行腕横韧带切除治疗32例,男8例,女24例;年龄46～66岁;B3型骨折21例,C1型骨折6例,C2型骨折4例,C3型骨折1例。采用单纯骨折切开复位"T"形钢板内固定治疗30例,男7例,女23例;年龄45～65岁;B3型骨折13例,C1型骨折9例,C2型骨折6例,C3型骨折2例。对两组术后迟发性腕管综合征发生率进行比较。结果:骨折切开复位"T"形钢板内固定并Ⅰ期行腕横韧带切除组32例,其中3例发生迟发性腕管综合征,而单纯骨折切开复位"T"形钢板内固定组30例,其中10例发生迟发性腕管综合征,两组差异有统计学意义(P<0.05)。结论:Ⅰ期行腕横韧带切除能较好地预防桡骨下端骨折掌侧切口术后迟发性腕管综合征。

Objective：To investigate the effects of open reduction by palm side for the distal radius fracture and T shape plate internal fixation with simultaneous anterior transverse carpal ligament resection for the prevention of delayed carpal tunnel syndrome after operation.Methods：From March 2000 to March 2007,32 patients（8 males and 24 females,ranging in age from 46 to 66 years） with distal radius fracture were treated with open reduction by palm side and T shape plate internal fixation with simultaneous anterior transverse carpal ligament resection;while 30 patients（7 males and 23 females,ranging in age from 45 to 65 years） only with open reduction by palm side and T shape plate internal fixation.The incidences of delayed carpal tunnel syndrome between the two groups were compared.Results：Among 32 patients treated with open reduction by palm side and T shape plate internal fixation with anterior transverse carpal ligament resection,3 patients had delayed carpal tunnel syndrome;while in 30 patients treated with open reduction by palm side and T shape plate internal fixation,10 patients had delayed carpal tunnel syndrome.There was significant statistically difference（P0.05%）.Conclusion：Simultaneous anterior transverse carpal ligament resection can effectively prevent the delayed carpal tunnel syndrome occurrence for the distal radius fracture with open reduction by palm side.