Mimics软件辅助下的掌侧Henry入路治疗C型桡骨远端骨折

Mimics Software-Assisted Volar Henry Approach for C-Type Distal Radius Fractures

目的研究在Mimics软件辅助下不切断旋前方肌的掌侧Henry入路治疗C型桡骨远端骨折的疗效及可行性。方法回顾性分析2014年3月至2016年3月以来收治的32例桡骨远端骨折患者,男13例,女19例;年龄23~86岁,平均43岁。手术时机为伤后0~7d,平均随访时间16.5个月。按照AO/ASIF分类:C1型12例,C2型5例,C3型2例。按随机数字表法分成2组:不切断旋前方肌组(观察组)16例,术前将CT数据导入mimics软件模拟手术复位,Henry入路暴露,于旋前方肌下插入钢板进行骨折复位固定。切断旋前方肌组(对照组)16例,经Henry入路暴露后切断旋前方肌暴露骨折端行骨折复位固定。术后2周、4周、3个月分别对患侧腕关节VAS评分、上肢DASH评分及前臂旋转、腕屈伸及内收、外展等功能进行评定、比较差异。结果术后1例对照组患者出现大鱼际肌区麻木,未出现感染、肌腱断裂等并发症。术后2周、4周VAS评分观察组明显优于对照组(P<0.05),术后3个月时两者比较差异无统计学意义(P=0.127)。上肢DASH评分及握力术后2周、4周观察组明显优于对照组(P<0.05),术后3个月两者比较差异无统计学意义(P>0.05)。腕关节活动度术后2周、4周优于对照组(P<0.05),术后3个月差异无统计学意义(P>0.05)。前臂旋转功能及握力较其他指标恢复更早。结论在mimics软件辅助下不切断旋前方肌治疗C型桡骨远端骨折方法可行,疗效确切,减少术中操作时间及不必要的损害,术后并发症少,保留了旋前方肌的功能,为术后腕关节早期功能锻炼提供源动力。

Objective The study the efficacy and feasibility of mimics software-assisted volar Henry approach in the treatment of C-type distal radius fractures without cutting the pronator quadratus.Methods Data of 32 patients with distal radius fractures who received treatment between March 2014 and March 2016（13 males and 19 females）were analyzed retrospectively.Patient age ranged from 23 to 86 years,with an average of 43 years.The operation opportunity was 0-7 days after injury.The average follow-up time was 16.5 months.According to AO/ASIF classification,there were 12 cases of type C1,5 cases of type C2 and 2 cases of type C3.These patients were randomly divided into two groups,with 16 patients in each group.In the observation group,CT data were preoperatively imported into mimics software to simulate surgical reduction and steel plate was inserted beneath the pronator quadrates for fracture reduction via Henry approach.In the control group,the open reduction was performed via Henry approach after cutting off the pronator quadrates.The VAS score,upper limb DASH score,forearm rotation,and wrist flexion,extension and adduction function were assessed at 2 weeks,4 weeks and 3 months after operation.Results After operation,a control patient had numbness in the thenar muscle region without infection,tendon rupture and other complications.Compared with control group,the VAS score,upper limb DASH score,grip strength and wrist mobility were significantly improved in observation group at 2 and 4 weeks after operation（P〈0.05）.No obvious differences were found between the two groups at 3 months after operation（P〉0.05）.Forearm rotation function and grip strength recovered earlier than other indexes.Conclusion Mimics software-assisted volar Henry approach without cutting the pronator quadratus for C-type distal radius fractures is a feasible and effective treatment,which reduces operation time,unnecessary harm and postoperative complications,preserves the integrity of pronator quadratus,and provides the power for early functional exercise of the wrist.