掌侧正中微创入路与Henry入路锁定钢板内固定治疗桡骨远端骨折的疗效比较

Comparison of locking plate internal fixation via middle palmar minimally invasive approach and Henry approach for distal radius fractures

目的比较掌侧正中微创入路和常规Henry入路锁定钢板内固定治疗桡骨远端骨折的疗效。方法纳入2014-10—2015-08诊治的桡骨远端骨折41例,按随机数字表法将患者分为微创入路组(采用掌侧正中微创入路)与Henry入路组(采用常规Henry入路)。结果 38例获得随访12~16个月,平均14.3个月。2组术后3 d桡骨高度、掌倾角及尺偏角,以及术后1年与术后3 d桡骨高度、掌倾角及尺偏角的差值差异无统计学意义(P>0.05)。术后1个月,微创入路组腕关节背伸、掌屈、旋前活动度,DASH评分明显优于Henry入路组,差异有统计学意义(P<0.05);但2组在腕关节旋后活动度、相对健侧握力、VAS评分方面差异无统计学意义(P>0.05)。术后2个月,微创入路组腕关节背伸、旋前活动度,DASH评分及VAS评分明显优于Henry入路组,差异有统计学意义(P<0.05);但2组腕关节掌屈、旋后活动度及相对健侧握力差异无统计学意义(P>0.05)。2组术后3、6、12个月腕关节主动活动度、相对健侧握力、DASH评分及VAS评分差异均无统计学意义(P>0.05)。结论掌侧正中微创入路与Henry入路锁定钢板内固定治疗桡骨远端骨折均可取得较好的疗效,而掌侧正中微创入路术后患者可早期进行功能锻炼,在一定程度上缩短患者术后康复时间。

Objective To compare the clinical efficacy of mininally invasive approach （MIA） and conventional Henry approach in locking plate internal fixation for distal radial fractures. Methods Forty-one patients with distal radial fractures between October 2014 to August 2015 were randomly divided into MIA groap（a =21） and Henry group（n =20） by the random number table. Results Thirty-eight patients completed the trial, who were followed for a mean period of 14.3 months, ranging 12-16 months. The radiographic parameters of radial length, ulnar inclination and palmar tilt were measured at 3 days postoperatively between MIA group and Henry group and the absolute values of the differences between the values of radiographic parameters at 12 months and 3 clays postoperatively had no significant difference （P 〉0.05）. At I month postoperatively, wrist extension and flexion, forearm pronation and Quick disability of the arm, shoulder, and hand（DASH） score got more improvement in MIA group（P 〈0.05）, and there were no obvious difference in supination, percentage of the grip power of the injured hand compared with that of the opposite hand and wrist pain visual analog sc, ale（VAS） score（P 〉0.05）. At 2 months postoperatively, wrist extension, forearm pronation, DASH and VAS score of MIA group were superior to that of Henry group（P 〈0.05）, and there were no significant difference between two groups in other outeomes（P 〉0.05）. At 3, 6 and 12 months, active range of motion of wrist, relative grip power, DASH and VAS score were not significant in statistics between MIA group and Henry group （P 〉0.05）. Conclusion Locking.plate internal fixation through minimal invasive approach or Henry approach both can get a satisfactory efficacy, but patients of MIA can perform functional exercises early and shorten the postoperative rehabilitation time to a certain extent.