经掌侧入路部分保留旋前方肌锁定接骨板治疗桡骨远端不稳定性骨折

Treatment of unstable fractures of the distal radius by internal fixation of locking compression plate with partialIy reserving pronator quadratus through volar approach

目的报告经掌侧人路部分保留旋前方肌的锁定接骨板治疗桡骨远端不稳定性骨折的疗效。方法自2014年1月至2016年12月应用锁定接骨板治疗109例桡骨远端不稳定性骨折患者，术中部分保留了旋前方肌，记录手术时间、术中失血量，根据影像学评价观察骨折愈合情况。采用Gartland-Werley评分量表评估腕关节功能情况。结果手术时间50～70min，平均（60±10）min；术中出血量10～20ml，平均（15±5）ml。109例患者均获得随访，时间12～36个月，平均20个月。骨折全部愈合，愈合时间为4～8周，平均6周。术后无骨折块移位、内固定失效、锁定接骨板螺钉松动或断裂、伤口感染等并发症发生。腕关节功能恢复良好，采用Gartland-Werley评分量表评价腕关节功能：优89例，良18例，中2例，优良率98．2％。1例拇长伸肌腱术后4个月断裂，12个月取出内固定时行掌长肌腱移植重建拇长伸肌腱伸拇功能。结论经掌侧入路部分保留旋前方肌锁定接骨板治疗桡骨远端不稳定性骨折，减少了软组织的过多剥离，保留了旋前方肌，并发症少，骨折愈合较快，腕关节功能恢复好，疗效确切。

Objective To report the clinical efficacy of internal fixation of locking compression plate with partially reserving pronator quadratus through volar approach in the treatment of unstable fractures of the distal radius. Methods From January 2014 to December 2016, 109 cases of unstable fractures of the distal radius were treated with locking compression plate. Part of pronator quadratus was reserved during the operation. The operation time and intraoperative blood loss were recorded. The fracture healing was evaluated by imaging observation. The wrist function was evaluated by Gartland- Werley Scoring Scale. Results The operation time ranged from 50 to 70 minutes with the average being （60±10） minutes. The intraoperative blood loss ranged from 10 to 20 ml with an average of（15± 5） ml. All the patients were follow-up for 12 to 36 months with an average of 20 months. All the fractures achieved healing. The healing time ranged from 4 to 8 weeks with the average being 6 weeks. No fracatre block displacement, internal fixation failure, locking plate and screw loosening or break, wound infection occurred. The wrist function recovered well. According to Gartland-Werley Scoring Scale, the wrist function was rated excellent in 89 cases, good in 18 cases and fair in 2 cases, with an excellent and good rate of 98.2%. The rupture of extensor hallucis longus tendon 4 months after the operation occurred in 1 case. Thumb extension of extensor pollicis longus muscle tendon was reconstructed by transplantation of palmaris longus tendon 12 months after the operation when removing the internal fixator. Conclusion The unstable fractures of the distal radius can be effectively treated by locking compression plate with partially reserving pronator quadratus through volar approach. It reduces the excessive dissection of the soft tissue, retains the pronator quadratus and has fewer complications, faster fracture healing, better wrist function recovery and definite curative effect.