掌侧入路保留旋前方肌治疗桡骨远端不稳定骨折的临床研究

Internal fixation via volar approach with pronator quadratus reserve for unstable distal radius fractures

目的探讨掌侧入路并保留旋前方肌的钢板内固定技术治疗桡骨远端不稳定骨折的临床疗效。方法从2011年3月至2013年3月,我科对收治的34例桡骨远端不稳定骨折患者进行掌侧入路切开复位钢板内固定术,术中予以保留旋前方肌。34例患者中,男性15例,女性19例;年龄24-76岁,平均57岁。按照AO/OTA分型：A3型4例,B1型3例,B2型11例,B3型10例,C1型6例。结果术后所有患者获得12-15个月的随访,平均13个月,末次随访时,骨折均愈合。无术后感染、内固定失败及骨折不愈合等并发症发生。根据Gartland-Werley标准评定疗效：优21例,良11例,可2例,优良率94.11%。结论掌侧入路保留旋前方肌的钢板内固定术治疗桡骨远端不稳定骨折能有效减少手术创伤及术后并发症,其疗效满意。

Objective To evaluate the efficacy of internal fixation via volar approach with pronator quadratus （PQ） reserve in treatment of unstable distal radius fractures. Methods Thirty four patients with unstable distal radius fractures were treated by open reduction and internal fixation via volar approach with PQ reserved from March 2011 to March 2013. Among these patients, there were 4 cases of A3, 3 of B1, 11 of B2, 10 of B3 and 6 of C1 according to AO/OTA classification. The series included 15 males and 19 females with an average age of 57 years old （24 -76）. Results All patients were followed up for 12 to 15 months with an average of 13 months, and all fractures were healed at the last follow-up. No postoperative infection, failure of fixation and nonunion were found. According to the Gartland and Werley wrist functional assessment, excellent results were obtained in 21 patients and good in 11 with an excellent and good rate of 94.1%. Conclusion Internal fixation via volar approach and with pronator quadratus reserve can provide a satisfactory clinical efficacy in treatingunstable distal radius fracture with reduced operative wound and complication rate.