两种手术入路治疗桡骨远端骨折的比较

Comparison of two approaches for the treatment of distal radius fractures

目的:探讨桡骨远端骨折开放复位内固定的有效手术入路。方法:回顾性选取采用锁定加压接骨板(LCP)治疗的桡骨远端骨折107例,其中男48例,女59例;年龄23～79岁,平均51.27岁。采用直接掌侧入路结合LCP固定治疗桡骨远端骨折55例,Henry入路结合LCP固定52例,对两组的手术特点、骨折显露时间、手术时间、正中神经并发症、旋前方肌修复率进行比较。术后1年随访时比较两组Gartland-Werley腕关节评分、握力、腕关节活动范围及影像学评分。结果:直接掌侧入路组、Henry入路组骨折显露时间分别为(21.18±1.69)min、(12.56±1.35)min,手术时间分别为(89.90±4.86)min、(61.58±4.37)min,术后正中神经刺激症状发生率分别为34.55%、5.77%,旋前方肌修复率分别为52.73%、100%,两组比较差异均有统计学意义(P<0.01)。术后1年按照Gartland-Werley评分标准评定手术疗效:直接掌侧入路组Gartland-Werley评分为3.25±2.29,优良率为90.91%;Henry入路组Gartland-Werley评分为2.92±2.13,优良率为92.31%,两组间差异无统计学意义(P>0.05);两组的腕关节活动范围、握力及影像学评分差异无统计学意义(P>0.05)。结论:Henry手术入路治疗桡骨远端骨折的疗效与直接掌侧入路相当,相比较具有解剖简单,操作容易,旋前方肌修复良好,术后正中神经并发症发生率低的优点,建议在掌侧入路治疗桡骨远端骨折中优先加以选用。

Objective：To discuss the effective operative approach for the treatment of distal radius fractures. Methods：From March 2003 to April 2010,107 patients with distal radius fractures suffered internal fixation with locking compression plate（LCP）. There were 48 males and 59 females with an average age of 51.27 years（ranged,23 to 79）. Of them,with directed volar approach was in 55 cases and Henry approach was in 52 cases. Surgical feature,fractured exposure time,operative time,median nerve complication,repair rate of the musculus pronator quadratus were compared between the two groups. Gartland-Werley wrist score（GW score）,range of motion of wrist joint,grasp force and imageology score were observed in two groups at the first year after operation. Results：The average fractured exposure time in directed volar approach group and Henry approach group was （21.18±1.69） min and （12.56±1.35） min,operative time was （89.90±4.86） min and （61.58±4.37） min,postoperative median nerve irritation rate was 34.55% and 5.77%,and repair rate of the musculus pronator quadratus was 52.73% and 100%,respectively;there was statistical difference between two groups（P0.01）. At the one-year after operation,GW score was 3.25±2.29,and with rate of excellent and good of 90.91% in directed volar approach group;in Henry approach group that was 2.92±2.13 and 92.31%,respectively;there was no statistical difference between two groups（P0.05）. There was no statistical difference in range of motion of wrist joint,grasp force and imageology score between two groups（P0.05）. Conclusion：Henry approach can obtain the same operative result compared with directed volar approach in treating distal radius fractures. Henry approach has advantage of simple anatomy,easy operation,better repair rate of the the musculus pronator quadratus and lower postoperative median nerve complication,which should be used preferentially to treat distal radius fractures.