两种手术入路方式对C型桡骨远端骨折锁定加压接骨板结合克氏针内固定术疗效的影响

Effect of two surgical approaches on the curative effect of locking compression plate and Kirschner wire internal fixation for type C distal radius fracture

目的探讨两种手术入路方式对C型桡骨远端骨折锁定加压接骨板结合克氏针内固定术疗效的影响。方法 2016年1月—2017年8月威海市立医院治疗96例C型桡骨远端骨折患者,均采用锁定加压接骨板结合克氏针内固定术治疗;随机分为掌侧入路组和背侧入路组,各48例;随访12～33个月,平均17.6个月。比较两组手术情况、不同时间点X线片参数、术后8周及术后12个月腕关节功能优良率、手术并发症发生情况。结果两组手术时间、术中出血量、术后住院时间、骨折愈合时间比较,差异均无统计学意义(P>0.05);两组术后及术后12个月与术前的掌倾角、尺偏角、桡骨高度比较,差异均有统计学意义(P<0.05),其中两组术前、术后及术后12个月的X线片参数比较,差异均无统计学意义(P>0.05);背侧入路组术后8周腕关节功能优良率为70.83%,明显高于掌侧入路组的50.00%,差异有统计学意义(P<0.05);两组术后12个月腕关节功能优良率比较,差异无统计学意义(P>0.05);两组患者均获得随访,其中两组早期并发症发生率比较,差异无统计学意义(P>0.05);掌侧入路组晚期并发症发生率为4.17%,明显低于背侧入路组的18.75%,差异有统计学意义(P<0.05)。结论不同手术入路影响C型桡骨远端骨折锁定加压接骨板结合克氏针内固定术的疗效,掌侧入路手术后早期腕关节旋前功能受影响,背侧入路手术后远期并发症较多,宜选用低切迹锁定加压接骨板并尽早拆除。

Objective To investigate the effect of two surgical approaches on the effect of locking compression plate combined with Kirschner wire internal fixation for type C distal radius fracture. Methods From Jan. 2016 to Aug. 2017,96 patients with type C distal radius fractures in Weihai Municipal Hospital were treated with locking compression plate combined with Kirschner wire internal fixation. The patients were randomly divided into the volar approach group and the dorsal approach group,with 48 cases in each group. They were followed up for 12 to 33 months,with an average of 17.6 months. The operation conditions,X-ray parameters at different time points,the excellent and good rate of wrist function 8 weeks postoperatively and 12 months postoperatively,and the occurrence of surgical complications were compared. Results There was no significant difference in the operation time,intraoperative blood loss,postoperative hospital stay,or fracture healing time between the two groups(P>0.05);the differences of palmar inclination angle,ulnar deviation angle and radius height before and 12 months after surgery between the two groups were statistically significant(P<0.05),and there was no significant difference in X-ray parameters between the two groups before,after and 12 months after surgery(P>0.05);the excellent and good rate of wrist joint function in the dorsal approach group was 70.83%,which was significantly higher than 50.00% in the volar approach group,and the difference was statistically significant(P<0.05);and there was no significant difference in the excellent and good rate of wrist joint function between the two groups at 12 months after operation(P>0.05);the patients in both groups were followed up,and there was no significant difference in the early incidence of complications between the two groups(P>0.05);the late incidence of postoperative complications in the volar approach group was 4.17%,significantly lower than that in the dorsal approach group(18.75%),and the difference was statistically significant(P<0.05). Conclusion Different surgical approaches affect the effect of locking compression bone plate and Kirschner wire internal fixation for C-type distal radius fractures,volar approach carries affected wrist pronation function,while posterior approach brings about long-term complications. Low profile locking compression plate should be used and removed as soon as possible.