两种不同手术入路治疗桡骨远端关节内骨折效果比较

INTRA-ARTICULAR DISTAL RADIUS FRACTURES:A COMPARISON OF TWO SURGICAL APPROACHES

目的比较两种不同手术入路治疗桡骨远端关节内骨折的效果。方法选取桡骨远端关节内骨折病人66例,按手术入路分为掌侧组35例,背侧组31例。掌侧组采取掌侧入路钢板内固定,背侧组则采取背侧入路钢板内固定,比较两组手术时间、术中出血量,手术切口及骨折愈合时间,术后掌倾角、尺偏角和桡骨高度,术后肩臂手功能（Dash）评分及腕功能（Gartland-Werley）评分;比较两组术前术后患、健侧腕关节屈曲、背伸、旋前及旋后活动范围百分比;比较两组术后并发症发生情况。结果两组术后掌倾角、尺偏角和桡骨高度与术前比较均有显著改善（t=60.87~76.67,P〈0.05）;掌侧组手术时间、术中出血量、切口愈合时间、上肢Dash评分、Gartland-Werley评分优良率及切口感染、延迟愈合、肌腱损伤、内固定物失效、神经损伤、腕管综合征等并发症发生情况与背侧组比较,差异均有显著性（t=2.09~14.19,χ^2=4.09~6.11,P〈0.05）。结论两种手术入路各有优劣,需要综合考虑病人具体情况进行选择。

Objective To compare the efficacy of two different surgical approaches for intra-articular distal radius fracture （IADRF）. Methods Sixty-six patients with IADRF were selected and divided into two groups as palm side group （n=35） and dorsal group （n=31） according to the surgical approach. Patients in the palm side group were treated with plate internal fixation through palm side approach, and those in the dorsal group received plate internal fixation through dorsal approach. A comparison was made between the two groups regarding the following items： operation time, blood loss at surgery, healing time of operative incision and fracture, postoperative volar tilting angle, ulnar inclination and radius height, DASH scores and Gartland-Werley scores. A comparison was made between before and after surgery in regard to the percentage of flexion, extension, pronation and supination. Postoperative complications were compared as well between the two groups. Results Postoperatively, volar tilting angle, ulnar inclination and radius height were improved in the two groups versus before surgery （t=60.87-76.67,P〈0.05）. The differences in operation time, blood loss at surgery, time of wound healing, Dash score, Gartland-Werley score and postoperative complications such as infection, tendon injury, nerve injury and carpal tunnel syndrome were significant between the two groups （t=2.09-14.19,χ^2=4.09-6.11,P〈0.05）. Conclusion Of the two surgical approaches, each has its advantages and disadvantages, as for the choice of the approach, the specific circumstances of the patient needs to be considered.