桡骨远端关节内粉碎骨折内固定术后疗效的影响因素分析及预测

Analysis of the influence factors after open reduction and internal fixation in the treatment of distal radial comminuted fractures

目的研究桡骨远端关节内粉碎骨折经切开复位锁定钢板内固定术后,影响腕关节功能恢复疗效的影像指标、活动、力量等因素的作用。方法回顾性研究收集自2013年5月至2015年10月桡骨远端关节内粉碎骨折病例36例,平均随访21.1月,骨折AO分型均为C型关节内粉碎骨折,均行切开复位锁定钢板内固定术。随访收集患者术前、术后2周内、术后3个月、6个月、12个月及随访终点的X线影像测量指标,包括测量正、侧位的掌倾角、尺偏角,关节面短缩畸形、桡骨茎突高度,收集患者术后3个月、6个月、12个月及随访终点的腕关节屈曲、背伸、旋前、旋后的活动范围,测量术后6个月、术后12个月及终点的病人患、健侧握力、旋前力矩,并形成评价G-W评分及DASH评分。对收集整理测量的资料以SPSS16.0统计软件行统计分析。结果术后2周、3个月、6个月、12个月及随访终点掌倾角度、桡骨关节面短缩、桡骨茎突高度临床指标较术前均有明显改善,术前与术后各测量值经单因素方差分析有统计学显著性差异(F=12.26~3.39,P=0.001~0.007);术后3个月、6个月、12个月的腕关节的屈曲角度、背伸角度、屈伸总角度、内旋角度、外旋角度、旋转总角度临床测量均逐渐改善,除屈曲角度外,其余各项各个随访时间点间有统计学显著性差异(F=6.02~3.68,P=0.001~0.029)。术后12个月时间点数据为标准,G-W评分及DASH评分与多因素行多元线性回归分析,G-W评分仅与关节旋转总角度、尺偏角有关,方程为g-w=23.8060-0.12×总旋转角度-0.12×尺偏角,R^2=0.89,F=37.47,P=0.001。DASH评分与患侧屈曲角度相关,方程为dash=5.322-0.03×屈曲角度-0.024×健侧旋前力矩,R^2=0.99,F=2100,P=0.015。结论桡骨远端粉碎骨折经锁定钢板内固定是确实有效的治疗方法,术后12个月各指标逐渐恢复至近正常并稳定,恢复至接近正常的时间顺序大致为先旋转、屈伸等运动角度,然后握力,最后是内旋力量。本组资料中,影响关节功能疗效的因素顺序是总旋转角度、腕关节屈曲角度,与其他因素无明显关系。

Objective To analysis the differences between the influence factors including reflex-extension rotation grip and imaging measurement after internal fixation in the treatment of distal radial fractures. Methods Following up 36 patients after open reduction and internal fixation operation in distal radius fractures in our hospital from May 2013 to October 2015,collecting data of the movement angle of the wrist including flexion,extension,rotation,pain,the wrist recovery function,the G-W score,DASH score,grip and the pronation strength of the patients,3 months,6 months,12 months and the following-up end point after operation,compare the differences of the means,analyze the liner regression between them with SPSS 16. 0. Results The radiologic results are significant improved 3 months,6 months,12 months,endpoint after operation with pre-operation（ F = 12. 26 - 3. 39,P = 0. 001 - 0. 007）. Except the pronation angle,the range of movement including the supination,reflexion,extention rotation are significantly different pre-and after operation（ F = 6. 02 - 3. 68,P = 0. 001 - 0. 029）. And G-W scoring are 2. 30,1. 37,1. 06,0. 96 3 months,6 months,12 months,endpoint after operation,also the DASH score are 7. 31,4. 50,2. 63,2. 593 months,6 months,12 months,endpoint after operation. The liner regression show that the G-W scoring are mainly influenced by the angle of rotation,regression equation are g-w = 23. 8060-0. 12 × angle-of-rotation-0. 12 × radial-inclination,R sqare = 0. 89,F = 37. 47,P =0. 001,The dash score are mainly influenced by the angle of reflextion,regression equation dash = 5. 322-0. 03 × angle-of reflexion-0. 024 ×pronation strength（ no-op）,R square = 0. 99,F = 2100,P = 0. 015. Conclusion On the basis of anatomic reduction 、internal fixation in the treatment of distal radial fractures,the wrist function recovery is mainly influenced by the angle of rotation、the angle of reflextion in turn,and pronation strength maybe important finally. There is no relationship with other factors.