改良Henry入路切开复位内固定在桡骨远端C型骨折治疗中的应用

Application of open reduction and internal fixation through modified Henry approach in treatment of C-type fractures of distal radius

目的前瞻性比较改良Henry入路和背侧入路切开复位内固定治疗桡骨远端C型骨折的效果差异，探讨改良Henry入路手术在此类骨折中的应用价值。方法选取2014年1月至2016年6月登封市人民医院收治的100例桡骨远端C型骨折手术患者作为研究对象，按照数字表法随机分为观察组与对照组，观察组采用改良Henry入路，对照组采用背侧入路。比较两组Cooney腕关节功能评分优良率，观察手术前后臂肩手残障（DASH）评分、桡骨掌倾角和尺偏角变化，同时记录术后并发症发生情况。结果观察组术后1个月Cooney腕关节功能评分优良率优于对照组（92%vs74%，P＜0.05）；两组患者术后DASH评分、桡骨掌倾角和尺偏角较术前均有一定程度的改善（P＜0.05），但观察组患者改善更加明显（P＜0.05）。随访时间3～22个月，平均随访时间6个月。随访期间观察组和对照组并发症发生率分别为4%（2/50）和20%（10/50），观察组显著低于对照组（P＜0.05）。结论与背侧入路比较，改良Henry入路治疗桡骨远端C型骨折能够有效改善患者腕关节功能，减小桡骨掌倾角和尺偏角，降低术后并发症发生率。

Objective To compare the differences of therapeutic effects of open reduction and internal fixation in treatment of distal radius C-type fractures through the modified Henry approach versus the dorsal approach,and to explore the application value of modified Henry approach.Methods A total of100patients with C-type fractures of distal radius treated in Denfeng People's Hospital from January2014to June2016,were randomly divided into the observation group(via modified Henry approach)and the control group(via the dorsal approach).Between these two groups,Cooney's wrist function scores were compared;Disabilities of arm,shoulder&hand(DASH)scores,as well as volar tilt angle and ulnar inclination angle were measured before and after the surgery;At the same time,the complications were also recorded.Results At one month postoperatively,the excellent and good rate of Cooney's wrist function scoring in observation group was superior than that in control group(92%vs74%,P<0.05).The postoperative DASH scores in two groups were all improved compared to preoperative one(P<0.05),and the improvement in observation group was better than that in control group(P<0.05).All patients were followed up for3-22months(average,6months).The difference of the rate of complications had statistical significance between the observation and the control groups during the follow-up(4%vs20%,P<0.05).Conclusion Compared to the dorsal approach,the modified Henry approach could improve the function of the wrist,decrease the volar tilt angle and ulnar inclination angle of the radius,and reduce the risk of postoperative complications for patients with C-type fracture of distal radius.