保留旋前方肌桡骨远端骨折内固定术的解剖学及临床研究

Anatomical and clinical study of internal fixation for distal radius fractures with pronator quadratus preserved

目的 探讨保留旋前方肌桡骨远端骨折内固定术的解剖学基础及其治疗桡骨远端骨折的疗效. 方法 取20具成人尸体上肢标本,男14具,女6具.解剖测量旋前方肌桡尺侧的长度、远近端的宽度,以及旋前方肌与桡骨远端关节面的距离、远近端骨性隧道的宽度、远端与腕横纹的距离.进一步了解旋前方肌的解剖特点.回顾性分析2015年3月至2017年3月期间采用保留旋前方肌、T型解剖锁定加压钢板内固定术治疗的18例桡骨远端骨折患者资料.男8例,女10例;年龄为28 ～ 65岁,平均52.7岁;骨折AO分型：23-A型8例,23-B型5例,23-C1型5例.末次随访时应用Cooney腕关节功能评分标准评定腕关节功能. 结果 旋前方肌为一近直角梯形的扁肌,血供丰富,其桡、尺侧长度平均分别为4.60、4.46 cm,远、近端宽度平均分别为4.41、4.48 cm.旋前方肌远端与腕横纹的距离平均为3.61 cm,远、近端骨性隧道宽度平均分别为3.08、1.91 cm.18例患者术后获平均11.5个月（6～36个月）随访.18例患者骨折均获愈合,愈合时间为2～3个月,平均2.5个月.末次随访时根据Cooney腕关节功能评分标准评定腕关节功能：评分为95 ～100分,平均97.7分;18例患者均为优. 结论 桡骨远端骨折横形骨折线位于旋前方肌的远端1/4 ～ 1/2之间,旋前方肌骨性隧道较宽.对于AO分型为23-A型、23-B型及23-C1型的骨折,采用保留旋前方肌远端置入钢板固定的术式是可行的,术后患者恢复快,腕关节功能恢复好.

Objective To explore the anatomic basis for and clinical outcomes of the internal fixation which preserves the pronator quadratus （PQ） for distal radius fractures.Methods Twenty cadaveric specimens of adult upper extremity were used for this study （14 males and 6 females）.The radial and ulnar lengths of PQ,the distal and proximal widths of PQ,the distances from the distal end of PQ to the articular surface of the distal radius and to the transverse line of the wrist,and the width of the bony tunnel of PQ were dissected and measured to study the anatomical features of PQ.A retrospective study was conducted of the 18 distal radius fractures which had been treated from March 2015 to March 2017 by internal fixation with T-shaped anatomic locking compression plate （LCP） with PQ preserved.They were 8 males and 10 females,with an average age of 52.7 years （range,from 28 to 65 years）.According to the AO classification,there were 8 cases of type 23-A,5 ones of type 23-B and 5 ones of type 23-C1.The functional outcomes of the wrist were assessed using the Cooney scoring system at the last follow-ups.Results The PQ muscle was flat and like a right angle trapezoid with rich blood vessels.The radial and ulnar lengths of PQ were about 4.60 cm and 4.46 cm;the distal and proximal widths of PQ were about 4.41 cm and 4.48 cm;the distance from the distal end of PQ to the transverse line of the wrist was about 3.61 cm;the widths of the distal and proximal bony tunnels were about 3.08 cm and 1.91 cm.The 18 patients were followed up for 6 to 36 months （average,11.5 months）.Bone union was achieved in all the patients after a mean time of 2.5 months （range,from 2 to 3 months）.The mean Cooney score for the wrist function was 97.7 （range,from 95 to 100） at the last follow-up,yielding an excellent rate of 100％.Conclusions The transverse line of the distal radius fracture is located between 1/4 and 1/2 of the distal PQ.The bony tunnel of PQ is wide enough.It is feasible to preserve the distal PQ muscle in the internal fixation of distal radius fractures of types 23-A,23-B and 23-C1,because it may lead to rapid recovery of the patients and satisfactory wrist function.